MAY-SAC-60

Code
MAY-SAC-60
Mercy ID
V-00054-02
Encounter Date
05/04/2000
Last
Maya
First
Sacramento
DOB
11/23/1960
County
Dekalb
Street
23 Chaffield Dr. Apt. A2
City
Stone Mt.
State
GA
Zip
30083-
Home
(770) 465-4027
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
Preschool

Spouse Information

Last
De la cruz
First
Oralia
DOB
02/15/1977
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
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
Dulce Maya 01/13/1999 Parents GA/USA
Maria Fernanda Maya 08/28/1996 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
R. Miranda
Data Entry
Y. Garcia
Referred By