PAV-IVI-74

Code
PAV-IVI-74
Mercy ID
V-01362-01
Encounter Date
10/06/2003
Last
Pavón
First
Ivis
DOB
12/29/1974
County
Gwinnett
Street
4853 Burns Rd.
City
Lilburn
State
GA
Zip
30043-
Home
(404) 542-9678
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Chirino
First
Juan ramon
DOB
01/07/1976
Address
N/A
Telephone
N/A
COB
Honduras
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
YES
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
Bryant Chirino 06/28/1998 Parents GA/USA
Jasmin Chirino 04/09/2000 Parents GA/USA
Tania Elizabeth Chirino 11/08/1992 N/A Honduras
NOTES
Permiso

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
x3737 Damaryz