CHA-JOS-79

Code
CHA-JOS-79
Mercy ID
V-01470-01
Encounter Date
01/26/2004
Last
Chacon
First
Josefa
DOB
08/11/1979
County
Fulton
Street
3136 Martin Luther King
City
Atlanta
State
GA
Zip
30311-
Home
(404) 472-9172
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Medrano
First
Erik
DOB
N/A
Address
N/A
Telephone
N/A
COB
Honduras
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Erik Omar Medrano 11/25/1998 Parents GA/USA
Jamil Ramsess Chacon 04/25/2000 Mother w/Stepfather GA/USA
Juan Carlos Chacon 08/26/1997 N/A Honduras
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