CAN-GRE-88

Code
CAN-GRE-88
Mercy ID
V-02665-01
Encounter Date
12/04/2007
Last
Canseco
First
Gregoria
DOB
12/10/1988
County
Rockdale
Street
1433 Forestville Ln.
City
Conyers
State
GA
Zip
30012-
Cell
(404) 468-0529
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
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
Ana Casares 04/04/2007 Mother GA/USA
Jose Casares 10/26/2005 Mother GA/USA

Former Spouse 1 Information

Last
Casares
First
Irinea
DOB
10/15/1980
Telephone
N/A
COB
Mexico
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
linea-Juana