VAC-CAT-70

Code
VAC-CAT-70
Mercy ID
V-02682-01
Encounter Date
12/28/2007
Last
Vaca
First
Catalina
DOB
05/05/1970
County
Dekalb
Street
5297 Chamblee Tucker Road
City
Chamblee
State
GA
Zip
30341-
Cell
(678) 529-1890
Family Status
Single parent w/children
COB
El Salvador
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
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
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
San Juana Rodriguez 08/05/1990 Mother GA/USA
Victor Moso 05/10/1998 Mother GA/USA

Former Spouse 1 Information

Last
Moso
First
Walter
DOB
07/19/1973
Telephone
N/A
COB
El Salvador
Home Owner
No
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