COS-ANA-85

Code
COS-ANA-85
Mercy ID
V-03279-01
Encounter Date
03/09/2010
Last
Coss
First
Analine
DOB
02/09/1985
County
Gwinnett
Street
5595 Running Fox Trail
City
Norcross
State
GA
Zip
30071-
Home
(678) 497-8180
Cell
(678) 206-1759
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

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
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
YES
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
David Hernandez 03/26/2009 Mother GA/USA
Maria Guadalupe Hernandez 01/08/2003 Mother GA/USA
Miguel A. Hernandez 09/13/2004 Mother GA/USA

Former Spouse 1 Information

Last
Fuentes
First
Miguel
DOB
01/08/1985
Telephone
N/A
COB
Mexico
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 de informacion