LAT-ELV-72

Code
LAT-ELV-72
Mercy ID
V-02767-01
Encounter Date
04/25/2008
Last
Nato
First
Elva
DOB
08/03/1972
County
Dekalb
Street
3353 Chamblee Tucker Rd.
City
Chamblee
State
GA
Zip
30341-
Cell
(404) 453-1685
Family Status
Single parent w/children
COB
Perú
Gender
Female
Housing
Single Family
Education Level
Vocational/Technical

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
YES
Consentimiento De Participar
YES

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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Carlos Medrano 05/27/2004 Mother GA/USA

Former Spouse 1 Information

Last
Medrano
First
Carlos
DOB
11/11/1981
Telephone
N/A
COB
El Salvador
Home Owner
No
NOTES

Media Authoritation

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