CHA-CAR-65

Code
CHA-CAR-65
Mercy ID
V-02053-01
Encounter Date
09/14/2005
Last
Chacon
First
Carolina
DOB
12/23/1965
County
Gwinnett
Street
3600 Jim Moore Rd
City
Dacula
State
GA
Zip
30019-
Cell
(678) 499-8810
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Chacon
First
Juan carlos
DOB
12/02/1976
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
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
Alicia Limones N/A Adulto/Soltero mexico
Rosalva Chacon 02/04/2005 Mother GA/USA
Teresa Chacon 06/06/1999 Mother GA/USA
NOTES

Media Authoritation

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