ALL-CHA-74

Code
ALL-CHA-74
Mercy ID
V-02505-01
Encounter Date
05/31/2007
Last
Allgood
First
Chan
DOB
12/22/1974
County
Dekalb
Street
1879 Shalloford Rd.
City
Tucker
State
GA
Zip
30084-
Cell
(678) 949-1766
Family Status
Single adult
COB
USA
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Mondragon
First
Simon
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
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
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
Osmad Cerez 12/15/2006 N/A 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
J. Manzo
Referred By
Felipe