VAZ-SIX-75

Code
VAZ-SIX-75
Mercy ID
V-00952-01
Encounter Date
06/14/2002
Last
Vazquez
First
Sixta
DOB
02/22/1975
County
Cobb
Street
2191 N. Lake Park
City
Smyrna
State
GA
Zip
30080-
Home
(770) 582-0183
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Vazquez
First
Sixta
DOB
02/22/1975
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
Jair Real 01/13/2002 Mother GA/USA
Pablo Real 09/09/2000 Mother GA/USA
Yadira Real 10/13/1999 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 Ma. Eugenia