BAC-GRI-64

Code
BAC-GRI-64
Mercy ID
V-01671-01
Encounter Date
08/12/2004
Last
Baca
First
Griselda
DOB
11/26/1964
County
Rockdale
Street
68 Magnolia
City
Conyers
State
GA
Zip
30012-
Home
(770) 922-1416
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Baca
First
Jose
DOB
08/06/1959
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
Griselda Baca 09/24/1991 Parents GA/USA
Hugo Baca 01/30/2001 Parents GA/USA
Jesus Baca 05/14/2004 Parents GA/USA
Jose Baca 10/21/1993 Parents 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