CHA-CHR-69

Code
CHA-CHR-69
Mercy ID
V-01659-01
Encounter Date
07/23/2004
Last
Chavez
First
Christin
DOB
10/22/1969
County
Fulton
Street
1225 Wood Creek Trail
City
Roswell
State
GA
Zip
30076-
Home
(404) 454-8353
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
H.S. equivalency diploma

Spouse Information

Last
Chavez
First
Orlando
DOB
N/A
Address
N/A
Telephone
N/A
COB
El Salvador
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
No
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No
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
x1375 Rafael Miranda