ELI-ANE-78

Code
ELI-ANE-78
Mercy ID
V-00886-01
Encounter Date
04/10/2002
Last
Eliassaint
First
Anen
DOB
09/22/1978
County
Gwinnett
Street
1355 Grave Rd
City
Norcross
State
GA
Zip
30093-
Home
(770) 414-5142
Family Status
Two parent family w/children
COB
Dominican Rep
Gender
Female
Housing
Not Homeless
Education Level
High school graduate

Spouse Information

Last
Eliassaint
First
Gabriel
DOB
06/24/1980
Address
N/A
Telephone
N/A
COB
EEUU
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
Bianen Eliassaint 09/05/2001 Parents GA/USA
NOTES
Signed consent form and promesa before the fire

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
Elena Wilson le dio el # de beeper de Juana