SAN-JOS-70

Code
SAN-JOS-70
Mercy ID
V-02413-02
Encounter Date
04/17/2007
Last
Sandoval
First
Jose luis
DOB
09/12/1970
County
Fulton
Street
13016 Gardner Dr.
City
Alpharetta
State
GA
Zip
30004-
Home
(770) 521-9531
Cell
(678) 549-6461
Work
(770) 993-9048
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Not Homeless
Education Level
College Degree

Spouse Information

Last
Maya
First
Blanca
DOB
06/19/1971
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
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
Benjamin Sandoval 07/26/2003 Parents GA/USA
Jose Luis Sandoval 10/19/2000 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
J. Manzo
Referred By
Felipe