PER-SAN-73

Code
PER-SAN-73
Mercy ID
V-00245-01
Encounter Date
06/28/2000
Last
Niño
First
Sandra
DOB
06/13/1973
County
Cobb
Street
660 Foot Path Lane
City
Marietta
State
GA
Zip
30062-
Cell
(678) 650-2719
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
David Perez 12/29/1991 Mother Mexico
Diana Perez 05/11/1993 Mother Mexico

Former Spouse 1 Information

Last
Perez
First
Bernardo
DOB
08/30/1960
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES
formerly known as Sandra Perez

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By