CHA-MAR-72

Code
CHA-MAR-72
Mercy ID
V-02075-01
Encounter Date
10/29/2005
Last
Chavez
First
Marlene
DOB
01/10/1972
County
Dekalb
Street
3417 Cumberland Ct. #1
City
Chamblee
State
GA
Zip
30341-
Home
(770) 455-9738
Family Status
Two parent family w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Chavez
First
Vicente
DOB
N/A
Address
N/A
Telephone
N/A
COB
Guatemala
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Carnen Chavez 02/28/2001 Parents GA/USA
Jorge Cardona 05/18/1993 Mother w/Stepfather GA/USA
Stefany chavez 04/17/2003 Parents GA/USA
Vicen P. Chavez 07/09/2005 Parents 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