BLA-MAR-66

Code
BLA-MAR-66
Mercy ID
V-00721-01
Encounter Date
10/23/2001
Last
Blazquez
First
Maria de lourdes
DOB
06/18/1966
County
Gwinnett
Street
2583 Gwinn Dr.
City
Norcross
State
GA
Zip
30071-
Home
(770) 448-6186
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Blazquez
First
Antonio
DOB
09/14/1968
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
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
No
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
Cindy Blazquez 08/07/1990 Mother GA/USA
Jocelyn Blazquez 07/03/1996 Mother GA/USA
Kathy Guillermina Blazquez 03/09/1988 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
x7764 Father Richard