DIA-RAY-79

Code
DIA-RAY-79
Mercy ID
V-00653-01
Encounter Date
08/21/2001
Last
Diaz
First
Raymunda
DOB
11/20/1979
County
Gwinnett
Street
2536 Wind Mere Dr.
City
Norcross
State
GA
Zip
30071-
Cell
(678) 768-4099
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
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
YES
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Fabiola Vasquez 10/12/2004 Mother GA/USA
Kevin Vargas Diaz 12/03/2000 Mother GA/USA
Luz Mary Vasquez 05/27/2003 Mother GA/USA

Former Spouse 1 Information

Last
Vargas
First
Zenon
DOB
04/12/1977
Telephone
N/A
COB
N/A
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
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
Evaluacion