AMA-KAR-82

Code
AMA-KAR-82
Mercy ID
V-03303-01
Encounter Date
04/20/2010
Last
Amador
First
Karen
DOB
02/15/1982
County
Clayton
Street
159 Black Forest
City
Stockbridge
State
GA
Zip
30281-
Home
(678) 759-1582
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Perez
First
Jose
DOB
05/24/1974
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
J. Derriy Amador 03/18/2010 Mother GA/USA
Karen J. Gamez 06/18/2005 Mother GA/USA
Keyli I Amador 12/19/2007 Mother GA/USA
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
llamo al cell de Griselda