AYA-CON-62

Code
AYA-CON-62
Mercy ID
V-01036-01
Encounter Date
11/13/2002
Last
Ayala
First
Concepcion
DOB
03/25/1962
County
Fulton
Street
5735 Roswell Rd. Apt. 407
City
Atlanta
State
GA
Zip
30342-
Home
(404) 255-1593
Cell
(770) 777-0806
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Ayala
First
Sergio
DOB
N/A
Address
N/A
Telephone
N/A
COB
Guatemala
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Gladen Ayala 11/16/1991 Parents GA/USA
Neidy Ayala 08/13/1990 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