PEL-AGU-68

Code
PEL-AGU-68
Mercy ID
V-03093-01
Encounter Date
06/01/2009
Last
Pelcastre
First
Agustina
DOB
05/28/1968
County
Fulton
Street
1483 Arthur Langford Jr. Pl. SW Apt. 9A4
City
Atlanta
State
GA
Zip
30315-
Cell
(678) 683-2182
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Preschool

Spouse Information

Last
N/A
First
N/A
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
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
Aldo Cruz 11/05/2007 Mother GA/USA
Estefany Cruz 06/06/2005 Mother GA/USA
Manuel Cruz 08/08/2002 Mother GA/USA

Former Spouse 1 Information

Last
Cruz
First
Manuel
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