DIA-TIR-83

Code
DIA-TIR-83
Mercy ID
V-02094-01
Encounter Date
10/21/2005
Last
Diaz
First
Tirza
DOB
09/15/1983
County
Dekalb
Street
1559 Esquire Place
City
Norcross
State
GA
Zip
30093-
Home
(770) 938-5404
Family Status
Two parent family w/children
COB
El Salvador
Gender
Female
Housing
Doubling Up
Education Level
High school graduate

Spouse Information

Last
Beltran
First
Juan carlos
DOB
10/07/1976
Address
N/A
Telephone
N/A
COB
El Salvador
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
Carlos Hernesto 06/13/2001 Parents GA/USA
Juan Jose Beltran 07/25/2005 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