BLA-ISA-72

Code
BLA-ISA-72
Mercy ID
V-01463-01
Encounter Date
01/16/2004
Last
Blanco
First
Isabel
DOB
05/22/1972
County
Fulton
Street
2350 Cobb Parkway Apt E20 Apt G
City
Smyrna
State
GA
Zip
30080-
Home
(770) 955-4188
Cell
(404) 252-7347
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Vocational/Technical

Spouse Information

Last
Olivares
First
Juan jesus
DOB
05/02/1967
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
YES

Children

NAME DOB LIVING WITH STATE/COUNTRY
Brandon Olivares 06/13/1997 Parents GA/USA
Rene Olivares 02/17/1996 Parents 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
x3737 Damaryz