GAL-ELV-77

Code
GAL-ELV-77
Mercy ID
V-03340-01
Encounter Date
06/04/2010
Last
Galvan
First
Elvira
DOB
02/10/1977
County
Dekalb
Street
70 lake Rd.
City
Covington
State
GA
Zip
30016-
Cell
(678) 768-3160
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Reyes
First
Juan
DOB
06/21/1966
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
YES
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
Alan Reyes 12/28/2005 Parents GA/USA
Itzel Reyes 10/09/2004 Parents GA/USA
Juan E.Reyes 07/22/2001 Parents GA/USA
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-Juana