BEN-HER-80

Code
BEN-HER-80
Mercy ID
V-03396-01
Encounter Date
09/15/2010
Last
Benitez
First
Hermenegilda
DOB
09/30/1980
County
Dekalb
Street
1512 Drook Court
City
Doraville
State
GA
Zip
30340-
Cell
(770) 256-2512
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade 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
YES
Consentimiento De Participar
YES

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

Former Spouse 1 Information

Last
Hernandez
First
Raul
DOB
11/11/1984
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

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