DIA-FAB-80

Code
DIA-FAB-80
Mercy ID
V-01244-01
Encounter Date
06/10/2003
Last
Diaz
First
Fabiola
DOB
10/12/1980
County
Fulton
Street
417 Green House Dr.
City
Roswell
State
GA
Zip
30076-
Home
(770) 912-3224
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Shelter
Education Level
some high school

Spouse Information

Last
Bustos
First
Edgar
DOB
02/20/1980
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
YES
Consentimiento De Participar
YES

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
Dulce Stefanny Lerva 10/26/2000 N/A GA/USA
Edgar Bustos Diaz 11/08/2001 N/A GA/USA
Nancy Xitlan Diaz 11/29/2002 N/A GA/USA
Veronica Michelle Lerva 11/01/1999 N/A GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
x3737 Damaryz