CHA-ALM-74

Code
CHA-ALM-74
Mercy ID
V-01074-01
Encounter Date
01/08/2003
Last
Chavez
First
Alma
DOB
09/10/1974
County
Cobb
Street
750 Franklin Rd. Apt. 21-E
City
Marietta
State
GA
Zip
00000-0000
Home
(678) 354-3217
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Agundez
First
Refugio
DOB
02/26/1970
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
YES
Stranger
YES

Children

NAME DOB LIVING WITH STATE/COUNTRY
Carlos 03/03/1995 Parents GA/USA
Jose Manuel Godoy 06/01/1992 Grandmother GA/USA
Lluvia 03/29/2002 Parents GA/USA
Mariela Graciela 01/28/2000 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By