BLA-MAR-62

Code
BLA-MAR-62
Mercy ID
V-02521-01
Encounter Date
06/11/2007
Last
Blanco
First
Maria de lourdes
DOB
05/12/1962
County
Fulton
Street
410 Riverwood Apt. A
City
Roswell
State
GA
Zip
99999-999
Cell
(678) 330-8174
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
H.S. equivalency diploma

Spouse Information

Last
Fayuco
First
Constantino
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
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
Eduardo Blanco 08/25/2004 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Juana