VIC-ADA-69

Code
VIC-ADA-69
Mercy ID
V-00955-02
Encounter Date
09/03/2002
Last
Vicente
First
Adan
DOB
02/26/1969
County
Cobb
Street
3513 Mustang Dr.
City
Powder spring
State
GA
Zip
30127-
Home
(678) 567-1246
Family Status
Two parent family w/children
COB
Guatemala
Gender
Male
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Vicente
First
Juana
DOB
12/08/1976
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
Alberto Vicente 07/20/1994 Parents GA/USA
Jashua 10/13/1997 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
R. Miranda
Data Entry
K. Aleman
Referred By
Marcela consejera