CER-MAR-84

Code
CER-MAR-84
Mercy ID
V-03268-01
Encounter Date
02/22/2010
Last
Cervantes
First
Maria patricia
DOB
06/01/1984
County
Gwinnett
Street
1635 Pirkle Road Apt. 610
City
Norcross
State
GA
Zip
30093-
Cell
(678) 500-6765
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Ruiz
First
Israel
DOB
04/17/1968
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
No
Consentimiento De Participar
No

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
No
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Brian S. Roa 01/28/2006 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Roa
First
Sebastian
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
Linea/ Clinica de la Mama