CHI-SEL-84

Code
CHI-SEL-84
Mercy ID
V-01946-02
Encounter Date
06/21/2005
Last
Chirino
First
Selvin
DOB
07/03/1984
County
Fulton
Street
3781 Mableton Apt #3
City
Atlanta
State
GA
Zip
30318-
Home
(678) 365-7435
Family Status
Adult coupie-no children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
Preschool

Spouse Information

Last
Gomez
First
Maribel
DOB
N/A
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
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
R. Miranda
Data Entry
K. Aleman
Referred By