AGU-CEC-77

Code
AGU-CEC-77
Mercy ID
V-02265-01
Encounter Date
06/07/2006
Last
Agustin
First
Cecilia
DOB
11/22/1977
County
Dekalb
Street
3552 Chamblee Tucker Rd
City
Doraville
State
GA
Zip
30340-
Home
(770) 934-4013
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Agustin
First
Cirino
DOB
06/12/1970
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
Adrian Agustin 08/08/1995 Parents GA/USA
Cirino Agustin 06/22/1998 Parents GA/USA
Esmeralda Agustin 04/08/2003 Parents GA/USA
Kevin Agustin 10/09/1992 Parents GA/USA
Ricardo Agustin 06/18/2000 Parents 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
R. Gonzalez
Referred By