CHA-MAR-68

Code
CHA-MAR-68
Mercy ID
V-03441-01
Encounter Date
10/12/2010
Last
Chacon
First
Martha
DOB
11/26/1968
County
Gwinnett
Street
6474 Summit Point Dr.
City
Norcross
State
GA
Zip
30092-
Cell
(770) 866-7408
Family Status
Two parent family w/children
COB
Ecuador
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Chacon
First
Javier
Middle
01046
DOB
01/04/1963
Address
N/A
Telephone
N/A
COB
Ecuador
Home Owner
YES
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
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
Ashley Chacon 04/09/2006 Parents GA/USA
Michelle Chacon 03/01/2004 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
linea-Juana