LAG-CAN-84

Code
LAG-CAN-84
Mercy ID
V-01851-01
Encounter Date
03/14/2005
Last
Lagos flores
First
Candy jacquelin
DOB
05/05/1984
County
Dekalb
Street
Peachtree Rd. #53E
City
Chamblee
State
GA
Zip
30341-
Home
(678) 480-5608
Cell
(770) 256-5489
Family Status
Single adult
COB
Honduras
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Herrera
First
Josue
DOB
02/26/1983
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
YES
Consentimiento De Participar
YES

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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Britney Lagos Flores 10/22/2003 Grandmother Honduras
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
K. Aleman
Referred By