PAD-GRA-77

Code
PAD-GRA-77
Mercy ID
V-03446-01
Encounter Date
10/04/2010
Last
Padilla
First
Graciela
DOB
07/26/1977
County
Dekalb
Street
3180 Clairmont
City
Atlanta
State
GA
Zip
30329-
Cell
(404) 909-7398
Family Status
Single parent w/children
COB
Mexico
Gender
Male Child
Housing
Doubling Up
Education Level
Grade school

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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Adan Jurado 09/26/2001 Mother GA/USA
Ana Lucia Jurado 05/07/2000 Mother GA/USA

Former Spouse 1 Information

Last
Jurado
First
Luciano
DOB
06/30/1964
Telephone
N/A
COB
Mexico
Home Owner
YES
NOTES

Media Authoritation

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