DIA-ELI-72

Code
DIA-ELI-72
Mercy ID
V-01637-01
Encounter Date
05/25/2004
Last
Diaz
First
Elida
DOB
10/22/1972
County
Clayton
Street
6347 Tara Bulevard
City
Jonesboro
State
GA
Zip
30236-
Home
(678) 479-6594
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Pachicano
First
Hugo
DOB
07/01/1968
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
No
Consentimiento De Participar
No

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
Raul Pachicano 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
x1375