CHA-ERI-82

Code
CHA-ERI-82
Mercy ID
V-02403-01
Encounter Date
02/07/2007
Last
Chavez
First
Erika
DOB
08/14/1982
County
Clayton
Street
5086 Old Dixie Hwy. Apt. 21
City
Forest park
State
GA
Zip
30297-
Cell
(404) 573-0486
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

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
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
YES
Consentimiento De Participar
YES

Petitioner

TPO
YES
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Analy Rivera 11/13/2009 Mother GA/USA
Gerardo rivera 06/21/2006 Mother GA/USA
Luis Montes 05/25/2002 Mother GA/USA

Former Spouse 1 Information

Last
Rivera
First
Martin
DOB
08/08/1977
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Juana