SAL-INE-69

Code
SAL-INE-69
Mercy ID
V-01085-01
Encounter Date
01/22/2003
Last
Salgado
First
Ines
DOB
01/21/1969
County
Gwinnett
Street
3525 Club Dr. Apt. 513
City
Lawrenceville
State
GA
Zip
30044-
Home
(678) 380-9887
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Balbuena
First
Martin
DOB
01/31/1971
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
YES
Consentimiento De Participar
YES

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
No
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
Alexis A. Balbuena 06/23/1991 Mother GA/USA
Nathaniel Balbuena 10/24/1996 Mother GA/USA
Vanessa C. Balbuena 08/09/1994 Mother 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
Mision/Walk In