CHA-WIL-75

Code
CHA-WIL-75
Mercy ID
V-02080-02
Encounter Date
10/18/2005
Last
Chavez
First
Wilson
DOB
06/03/1975
County
Dekalb
Street
3419 Cumberland Ct. H4
City
Chamblee
State
GA
Zip
30341-
Home
(404) 935-2754
Family Status
Two parent family w/children
COB
Guatemala
Gender
Male
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Vasquez
First
Lorena cux
DOB
06/03/1978
Address
N/A
Telephone
(404) 935-2754
COB
Guatemala
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
YES
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
Ashley Chavez 10/23/2002 Parents GA/USA
NOTES

Media Authoritation

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