REY-BLA-74

Code
REY-BLA-74
Mercy ID
V-01435-01
Encounter Date
12/08/2003
Last
Reyes
First
Blanca
DOB
08/06/1974
County
Gwinnett
Street
162 Spring Bottom Dr.
City
Lawrenceville
State
GA
Zip
30045-
Home
(678) 377-9163
Cell
(678) 985-0955
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Vocational/Technical

Spouse Information

Last
Torrez
First
Felipe
DOB
12/13/1978
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
Angie Torrez 12/21/2002 N/A GA/USA
Kevin Torrez 08/13/1996 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
R. Miranda
Referred By
Rafael-Evaluacion