DIE-CAR-62

Code
DIE-CAR-62
Mercy ID
V-00141-02
Encounter Date
03/13/2000
Last
Diez
First
Carlos
DOB
04/30/1962
County
Gwinnett
Street
3450 Breckin Ridge Apt. 923-B
City
Duluth
State
GA
Zip
30096-
Home
(770) 931-1714
Family Status
Two parent family w/children
COB
Colombia
Gender
Male
Housing
Doubling Up
Education Level
Vocational/Technical

Spouse Information

Last
Diez
First
Leysi
DOB
07/02/1965
Address
3450 Brecking Ridge Apt. 923-B
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
SOLO
No
Court Mandated
No
Program Completed
YES
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
Lesly Diez 09/03/1988 Parents Colombia
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
R. Miranda
Data Entry
Y. Garcia
Referred By