ACO-ELE-66

Code
ACO-ELE-66
Mercy ID
V-01507-01
Encounter Date
03/01/2004
Last
Acosta
First
Elena
DOB
01/12/1966
County
Gwinnett
Street
4280 Souph Lee St.
City
Buford
State
GA
Zip
30518-
Home
(678) 714-7457
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Adult, no formal education

Spouse Information

Last
Carillo
First
Luis
DOB
N/A
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
Gloria Carillo N/A N/A GA/USA
Maria Elena N/A N/A GA/USA
Rodrigo N/A 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