VIA-EDI-83

Code
VIA-EDI-83
Mercy ID
V-03432-01
Mother ID
V-03432-01
Encounter Date
09/28/2010
Last
Viazcan
First
Edith
DOB
02/25/1983
County
Dekalb
Street
6800 Peachtree Boulevard B-16
City
Atlanta
State
GA
Zip
30360-
Cell
(404) 566-1457
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Hernandez
First
Carlos
DOB
06/13/1977
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
YES

Children

NAME DOB LIVING WITH STATE/COUNTRY
Juan Carlos Viazcan 06/24/2001 Mother GA/USA
Luis Enrique Garcia 12/05/1999 Grandmother Indiana/USA-Materna
Paloma G. Viazcan 08/10/2002 Grandmother Indiana/USA-Materna
Yendy Garcia 08/03/2001 Grandmother Indiana/USA-Materna
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
linea-Juana