DIA-LIS-72

Code
DIA-LIS-72
Mercy ID
V-01886-01
Encounter Date
04/27/2005
Last
Diaz
First
Lisbeth
DOB
12/30/1972
County
Gwinnett
Street
4498 Buford Hwy #203
City
Norcross
State
GA
Zip
30071-
Home
(678) 558-2421
Cell
(678) 755-8251
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
No
Stranger
YES

Children

NAME DOB LIVING WITH STATE/COUNTRY
Ever Juan Carlos Chonay 04/19/1994 Mother GA/USA
Jaz-lyn Martel 09/25/2001 Mother GA/USA
Joselyn Martel 09/25/2001 Mother GA/USA
Mirian Liseth Guzman 01/16/1992 Grandparents Guatemala
Nick Alexander Mera 06/20/1998 Mother GA/USA

Former Spouse 1 Information

Last
Martel
First
Eloy
DOB
11/14/1974
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES
Tambien con el apellido Chonay

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
K. Aleman
Referred By