MEN-ANG-64

Code
MEN-ANG-64
Mercy ID
V-01269-02
Encounter Date
07/01/2003
Last
Mendoza vazquez
First
Angel
DOB
07/28/1964
County
Dekalb
Street
3137 Moss Oak Dr.
City
Doraville
State
GA
Zip
30340-
Home
(770) 729-0754
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
Adult, no formal education

Spouse Information

Last
Diaz
First
Marina
DOB
N/A
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
Dulcina Nancy Mendoza N/A Grandmother GA/USA
Fachely Mendoza N/A N/A GA/USA
Nelma Mendoza N/A N/A 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
K. Aleman
Referred By
x3737