GAS-JUA-79

Code
GAS-JUA-79
Mercy ID
V-01607-01
Encounter Date
05/21/2004
Last
Gaspar torres
First
Juana
DOB
08/04/1979
County
Dekalb
Street
3305 Midway Rd.
City
Decatur
State
GA
Zip
30032-
Cell
(678) 522-2493
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Mendez
First
Juan
DOB
07/22/1982
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
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Azucena Abigail Equihua 09/17/1995 N/A Mexico
Juan Damian Gaspar 04/17/1997 N/A Mexico
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
Cliente/Walk-in