CAS-MAR-70

Code
CAS-MAR-70
Mercy ID
V-03374-01
Encounter Date
07/27/2010
Last
De castañon
First
Maricela
DOB
12/25/1970
County
Fulton
Street
307 Briahill Ln.
City
Atlanta
State
GA
Zip
30324-
Cell
(678) 887-6845
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
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
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
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
Anuar Chavez 02/05/1997 Mother GA/USA
Felipe Chavez 10/26/1990 Mother GA/USA
Stuwar Chavez 07/28/1992 Mother GA/USA

Former Spouse 1 Information

Last
Chavez
First
Felipe
DOB
06/19/1974
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
Miceli Mondragon-Hna.