TAV-ALB-54

Code
TAV-ALB-54
Mercy ID
V-03330-01
Encounter Date
05/18/2010
Last
Tavarez
First
Alba
DOB
05/10/1954
County
Dekalb
Street
3061 Oakcliff Rd. # 115
City
Doraville
State
GA
Zip
30340-
Home
(770) 455-9774
Family Status
Single adult
COB
Colombia
Gender
Female
Housing
Doubling Up
Education Level
High school graduate

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
YES
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
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

Former Spouse 1 Information

Last
Tavarez
First
Angel
DOB
06/30/1954
Telephone
N/A
COB
Puerto Rico
Home Owner
YES
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
walk in