BAH-SOC-67

Code
BAH-SOC-67
Mercy ID
V-02952-01
Encounter Date
12/02/2008
Last
Bahena
First
Socorro
DOB
06/23/1967
County
Fulton
Street
201 Northwood Cr.
City
Atlanta
State
GA
Zip
30342-
Cell
(404) 438-5930
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Preschool

Spouse Information

Last
Carnalla
First
Silvestre
DOB
06/20/1965
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
Andy Carnalla 02/09/2005 Parents GA/USA
Mario Roman 09/01/1996 Mother w/Stepfather GA/USA
Xochilt Carnalla 05/14/2002 Parents 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
Jacqueline-Entrevista