BLA-MIR-74

Code
BLA-MIR-74
Mercy ID
V-00835-01
Encounter Date
02/11/2002
Last
Blancas
First
Mirza
DOB
07/30/1974
County
Dekalb
Street
2204 Plaster Rd. Apt. H
City
Atlanta
State
GA
Zip
30345-
Home
(404) 808-0696
Family Status
Single adult
COB
Perú
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Mojica
First
Cesar
DOB
07/02/1970
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Maria Daniela 01/06/1994 Father GA/USA
Renato 02/23/1991 Father 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 Ma. Eugenia