BLA-FLO-81

Code
BLA-FLO-81
Mercy ID
V-02997-01
Encounter Date
02/05/2009
Last
Blancas
First
Flor
DOB
05/29/1981
County
Rockdale
Street
146 West Meadow Lane
City
Conyers
State
GA
Zip
30012-
Home
(770) 593-1447
Cell
(770) 827-2789
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Some College

Spouse Information

Last
Cruz
First
Francisco
DOB
08/30/1978
Address
N/A
Telephone
(770) 593-1447
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
YES
Consentimiento De Participar
YES

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
Avelardo Cruz 03/10/2005 Parents GA/USA
Enrique Cruz 12/10/2004 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
J. Manzo
Referred By
Jacqueline-Compañero en CL