LOY-ELM-75

Code
LOY-ELM-75
Mercy ID
V-01586-01
Encounter Date
05/04/2004
Last
Loyola
First
Elma
DOB
05/20/1975
County
Dekalb
Street
1377 Briarwood Rd. A4
City
Atlanta
State
GA
Zip
30345-
Home
(770) 256-8254
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Cabrera
First
Delfino
DOB
12/26/1967
Address
N/A
Telephone
(770) 256-8010
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Gustavo Adolfo Carillo 04/17/1997 Grandmother Mexico
Marta Beatriz Carillo 08/18/1998 Grandmother Mexico
Nicolas Carillo 01/17/2000 Grandmother Mexico
Rosi Aimee Carillo 01/09/1994 Grandmother Mexico

Former Spouse 1 Information

Last
Carillo
First
Nicolas
DOB
03/27/1963
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

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
Walk-in Mision