REY-EVA-69

Code
REY-EVA-69
Mercy ID
V-03402-01
Encounter Date
08/24/2010
Last
Reyna
First
Evangelina
DOB
03/10/1969
County
Gwinnett
Street
5817 Brooklyn Lane
City
Norcross
State
GA
Zip
30093-
Cell
(770) 866-6775
Other
(770) 925-6952
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
High school graduate

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
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
Carlos Reyna 04/07/1994 Mother GA/USA
Daniel Coleman 07/25/1999 Mother GA/USA
Karina Reyna 10/06/1991 Mother GA/USA
Yadira Reyna 04/21/1990 Mother GA/USA

Former Spouse 1 Information

Last
Coleman
First
Douglas
DOB
04/27/1956
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
cell/Jackie