CHA-JOS-65

Code
CHA-JOS-65
Mercy ID
V-00702-01
Encounter Date
10/03/2001
Last
Chavez
First
Josefina
DOB
02/20/1965
County
Clayton
Street
8988 Dorsy Road
City
Riverdale
State
GA
Zip
30274-
Home
(404) 435-4147
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Chavez
First
Richard
DOB
06/08/1966
Address
N/A
Telephone
N/A
COB
EEUU
Home Owner
YES
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Casandra Brenda Chavez 07/30/1997 Parents GA/USA
Kelly Chavez 06/09/2004 Parents GA/USA
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
TV