COR-MAR-65

Code
COR-MAR-65
Mercy ID
V-00416-02
Encounter Date
02/20/2001
Last
Correa
First
Martin
DOB
07/28/1965
County
Fulton
Street
819 Tahoe Run Apt. J
City
Roswell
State
GA
Zip
30076-
Home
(770) 640-4678
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Garcia
First
Juana
DOB
03/19/1967
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
Jaimy 09/16/1985 Parents GA/USA
Jasmin 12/12/1993 Parents GA/USA
Omar 04/09/1994 Parents GA/USA
Sergio 09/22/1996 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
F. Perez
Data Entry
K. Aleman
Referred By
Fulton-Morgan