CHU-ANA-83

Code
CHU-ANA-83
Mercy ID
V-03033-01
Encounter Date
03/24/2009
Last
Chula
First
Ana lilia
DOB
06/27/1983
County
Fulton
Street
653 Morozco Drive
City
Atlanta
State
GA
Zip
30324-
Cell
(404) 957-6082
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
High school graduate

Spouse Information

Last
Sugia
First
Fernando
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
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
Darian Sugia 07/24/2008 Parents GA/USA
Victor M. Molina 08/29/2005 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Molina
First
Victor
DOB
N/A
Telephone
N/A
COB
N/A
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
Jacqueline