DIA-JOS-55

Code
DIA-JOS-55
Mercy ID
V-00014-02
Encounter Date
02/02/2000
Last
Diaz
First
Jose
DOB
11/01/1955
County
Fulton
Street
55 northwood drive apt f 18
City
Atlanta
State
GA
Zip
30342-
Home
(404) 943-9361
Family Status
Two parent family w/children
COB
El Salvador
Gender
Male
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Diaz
First
Alicia
DOB
02/06/1960
Address
N/A
Telephone
N/A
COB
El Salvador
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
YES
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
No
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
F. Perez
Data Entry
S. Aviña
Referred By