BAU-AID-80

Code
BAU-AID-80
Mercy ID
V-03392-01
Encounter Date
08/20/2010
Last
Bautista
First
Aida
DOB
01/23/1980
County
Cobb
Street
2345 Cobb Parkway
City
Smyrna
State
GA
Zip
30080-
Cell
(404) 438-3721
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Contreras
First
Eduardo
DOB
07/22/1982
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
Jair Galarza 10/26/2003 Mother w/Stepfather GA/USA
Jennifer Galarza 12/02/1998 Mother w/Stepfather GA/USA
Yissel Galarza 05/08/2000 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Galarza
First
Jose i
DOB
04/12/1975
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
J. Perez
Data Entry
J. Manzo
Referred By
linea-Juana & Cepta