BEL-AZU-72

Code
BEL-AZU-72
Mercy ID
V-01172-01
Encounter Date
03/25/2003
Last
Beltran
First
Azucena
DOB
04/12/1972
County
Dekalb
Street
2296 Apt. G Dunwoody
City
Atlanta
State
GA
Zip
30338-
Home
(770) 986-0351
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Mauricio
First
Jose juan
DOB
08/10/1977
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
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Ana Laura Pantoja 12/02/1995 Mother GA/USA
Juan Angel Mauricio 10/03/2000 Grandmother Mexico
Viridiana Pantoja 10/21/1988 Mother 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
WRC