PEÑ-VER-77

Code
PEÑ-VER-77
Mercy ID
V-01862-01
Encounter Date
11/22/2005
Last
Peña diaz
First
Veronica
DOB
02/03/1977
County
Dekalb
Street
809 Regency Wood #2
City
Atlanta
State
GA
Zip
30319-
Home
(770) 912-8275
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Galeana
First
Jesus
DOB
02/06/1976
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Brenda Galeana 01/07/1996 Parents Mexico
Jesus A. Galeana 09/24/2000 Parents Mexico
Luis F Galeana 07/31/1998 Parents Mexico
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
R. Gonzalez
Referred By
Fabiola Gomez