JUA-BLA-01

Code
JUA-BLA-01
Mercy ID
V-00495-01
Encounter Date
05/02/2001
Last
Juarez
First
Blanca
DOB
05/02/1978
County
Dekalb
Street
6800 peachtree industrial apt d-9
City
Doraville
State
GA
Zip
30360-
Home
(404) 218-2916
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Perez
First
Mauricio
DOB
N/A
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No
NOTES

Media Authoritation

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