SER-DIN-86

Code
SER-DIN-86
Mercy ID
V-03429-01
Encounter Date
09/22/2010
Last
Serna
First
Dina
DOB
02/08/1986
County
Gwinnett
Street
3479 Dianthus
City
Larenceville
State
GA
Zip
30044-
Cell
(678) 994-3563
Family Status
Two parent family w/children
COB
El Salvador
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Serna
First
Fredy
DOB
08/16/1983
Address
N/A
Telephone
N/A
COB
Colombia
Home Owner
No
Driver
YES
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
Christher Serna 03/13/2009 Parents 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