DIA-ALI-80

Code
DIA-ALI-80
Mercy ID
V-02715-01
Encounter Date
02/19/2008
Last
Diaz
First
Alicia
DOB
04/21/1980
County
Fulton
Street
1237 Woodcreek Circle
City
Roswell
State
GA
Zip
30076-
Cell
(678) 368-7053
Work
(678) 867-9854
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Velazquez
First
Julian
DOB
02/10/1981
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
Allison Rivera 10/10/2005 Grandmother GA/USA
Esquiel Diaz 03/28/1999 Grandmother GA/USA
Julian Velazquez 06/05/2006 Mother GA/USA

Former Spouse 1 Information

Last
Rivera
First
Jose luis
DOB
11/09/1978
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