CHA-ALI-64

Code
CHA-ALI-64
Mercy ID
V-00293-01
Encounter Date
09/25/2000
Last
Chavez
First
Elia
DOB
04/17/1964
County
Fulton
Street
5123 marlene dr
City
Roswell
State
GA
Zip
30075-
Home
(770) 642-5479
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Zuñiga
First
Agustin
DOB
08/28/1966
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
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
norma zuniga 12/21/1989 Parents GA/USA
uriel zuniga 11/01/1991 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
S. Aviña
Referred By
jerry 7764