DIA-ALE-65

Code
DIA-ALE-65
Mercy ID
V-00169-01
Encounter Date
04/12/2000
Last
Diaz
First
Alejandra
DOB
02/04/1965
County
Gwinnett
Street
3663 west chase village ln
City
Norcross
State
GA
Zip
30092-
Home
(770) 441-0391
Family Status
Single parent w/children
COB
Puerto Rico
Gender
Female
Housing
Not Homeless
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
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
alejandra diaz 07/27/1987 Mother GA/USA
betty diaz 03/30/1982 Mother GA/USA
betzy diaz 02/10/1981 Mother GA/USA
gabriela diaz 07/27/1987 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
S. Aviña
Referred By