FIT-ANA-72

Code
FIT-ANA-72
Mercy ID
V-03274-01
Encounter Date
03/01/2010
Last
Fitzgerald
First
Ana
DOB
09/20/1972
County
Gwinnett
Street
1540 Maple Point Court
City
Lawrenceville
State
GA
Zip
30043-
Cell
(678) 768-2034
Family Status
Single adult
COB
Venezuela
Gender
Female
Housing
Single Family
Education Level
H.S. equivalency diploma

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
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
Vanessa Mosqueda 08/03/1993 Grandmother Venesuela-Materna

Former Spouse 1 Information

Last
Fitzgerald
First
Craig
DOB
04/04/1967
Telephone
N/A
COB
USA
Home Owner
YES
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
Linea-Juana