AMU-DIA-74

Code
AMU-DIA-74
Mercy ID
V-02319-01
Encounter Date
09/06/2006
Last
Amu
First
Diana
DOB
03/03/1974
County
Dekalb
Street
3612 plasantdale Rd. # 22
City
Doraville
State
GA
Zip
30340-
Cell
(678) 683-7014
Family Status
Single parent w/children
COB
Colombia
Gender
Female
Housing
Single Family
Education Level
Adult, no formal education

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
Home Owner
No
Driver
No
Home Owner
YES
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
Camila Villegas 03/20/2000 Mother GA/USA
Cristian Villegas 05/12/1997 Mother GA/USA
Javier Villegas 01/07/1996 Mother GA/USA

Former Spouse 1 Information

Last
Sapien
First
Francisco
DOB
05/19/1972
Telephone
N/A
COB
Mexico
Home Owner
No

Former Spouse 2 Information

Last
L?????????????????????????????
First
L?????????????????????????????
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
Angelica Diosdado