AVA-MAU-80

Code
AVA-MAU-80
Mercy ID
V-03047-01
Encounter Date
04/01/2009
Last
Avalos
First
Mauricia
DOB
09/22/1980
County
Gwinnett
Street
999 no la uiso dar
City
Duluth
State
GA
Zip
30096-
Cell
(404) 492-2009
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Santillan
First
Victor
DOB
01/22/1979
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
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
Michael Chavez 01/13/2003 Mother w/Stepfather GA/USA
Nelson Chavez 08/08/2000 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Chavez
First
Nelson
DOB
03/14/1981
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
Linea-Griselda