SEG-NOR-60

Code
SEG-NOR-60
Mercy ID
V-00318-01
Encounter Date
10/20/2000
Last
Segura
First
Norma
DOB
01/04/1960
County
Rockdale
Street
2195 West High Tower Trail
City
Conyers
State
GA
Zip
30012-
Cell
(678) 349-8063
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Adult, no formal education

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
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
Bernardo Santana 04/10/1981 Mother GA/USA
Edith Santana 03/10/1986 Mother GA/USA
Esbelda Y. Santana 03/31/2000 Mother GA/USA
Everardo Santana 11/29/1992 Mother GA/USA
Hector Santana 02/08/1998 Mother GA/USA
Humberto Santana 05/02/1982 Mother GA/USA
Manuel Santana 01/20/1983 Mother GA/USA
Pablo Santana 12/14/1987 Mother GA/USA
Perfecto Santana 10/23/1979 Mother GA/USA

Former Spouse 1 Information

Last
Gomez
First
Lucio
DOB
12/13/1980
Telephone
N/A
COB
Mexico
Home Owner
No

Former Spouse 2 Information

Last
L?????????????????????????????
First
L?????????????????????????????
DOB
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
S. Aviña
Referred By
ma eugenia 7764