DIA-NOE-81

Code
DIA-NOE-81
Mercy ID
V-03498-01
Encounter Date
01/18/2011
Last
Diaz
First
Noelia
DOB
01/30/1981
County
Cherokee
Street
2918 Harmin Lane
City
Woodstock
State
GA
Zip
30188-
Cell
(404) 849-3658
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Sanchez
First
Roberto
DOB
09/12/1964
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
Fusiel Gutierrez 07/26/2000 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Gutierrez
First
Gabriel
DOB
04/10/1974
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-Juana