VAR-LOU-74

Code
VAR-LOU-74
Mercy ID
V-01308-01
Encounter Date
08/05/2003
Last
Varela
First
Lourdes
DOB
02/11/1974
County
Dekalb
Street
3574 Bufford Hwy Apt. 4
City
Chamblee
State
GA
Zip
30329-
Home
(404) 325-5796
Cell
(404) 583-1147
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Fragozo
First
Ricardo
DOB
04/03/1973
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Ana Karen Fragozo 10/07/2000 Parents GA/USA
Eduardo Fragozo 02/11/1993 Parents GA/USA
Humberto Fragozo 09/24/1990 Parents GA/USA
Jose Ulises Fragozo 11/20/1995 Parents 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
x3737 Damaryz