TAP-BEN-68

Code
TAP-BEN-68
Mercy ID
V-00037-01
Encounter Date
01/17/2000
Last
Tapia
First
Benita
DOB
02/12/1968
County
Dekalb
Street
3629 admiral dr
City
Chamblee
State
GA
Zip
30341-
Home
(770) 457-3257
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Hernandez
First
Alfredo
DOB
02/22/1967
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
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
ivan hernandez 03/30/1999 Mother GA/USA
vanessa hernandez 07/21/1997 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
S. Aviña
Referred By