CHA-MAR-71

Code
CHA-MAR-71
Mercy ID
V-01203-01
Encounter Date
04/22/2003
Last
Chacon
First
Marta
DOB
11/21/1971
County
Fulton
Street
663 Northwood Dr. NE Apt. 160
City
Atlanta
State
GA
Zip
30342-
Home
(770) 745-1914
Cell
(770) 754-6343
Family Status
Two parent family w/children
COB
El Salvador
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Mendoza
First
Angel
DOB
09/15/1975
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
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
Jaqueline Chacon 11/29/2000 N/A GA/USA
Martha Constansa Chacon 02/27/1991 Mother w/Stepfather GA/USA
Samuel Anthony Chacon 11/28/1999 Mother w/Stepfather 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