HER-BLA-75

Code
HER-BLA-75
Mercy ID
V-02008-01
Encounter Date
08/15/2005
Last
Hernandez
First
Blasa
DOB
02/03/1975
County
Clayton
Street
976 Forest Ave.
City
Forest park
State
GA
Zip
30297-
Home
(404) 361-3302
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Morales
First
Ricardo
DOB
10/17/1973
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
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Briana Morales 11/29/1992 Mother GA/USA
Christian Morales 07/31/2003 Mother GA/USA
Ricardo Morales 01/29/1998 Mother GA/USA
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