Pancho - VAS-ERI-79

Code: VAS-ERI-79
Mercy ID: V-00187-01
Encounter Date: 04/25/2000
Last: Vazques
First: Eriselda
DOB: 03/15/1979
County: Fulton
Street: 4558 Roswell Rd. H-4
City: Atlanta

State

Zip

30342-

Home

(404) 531-0559

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Grade school

Spouse Information

Last: Chavez
First: Medardo
DOB: 09/08/1977

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
DFACS County
Alcohol & Drug: No
# of DUIs
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

As A Child

Relative

Stranger

As An Adult

Partner

Relative

Stranger

Children

NAME	DOB	LIVING WITH	STATE/COUNTRY
Medardo Vasquez	01/08/2000	Parents	GA/USA
Raymundo Vasquez	04/15/1996	Parents	GA/USA
Yaritza Vasquez	06/23/2001	Parents	GA/USA

Former Spouse 1 Information

Last: Chavez
First: Gildardo
DOB: 06/13/1976
Telephone: N/A
COB: N/A
Home Owner: No

NOTES

Gildardo Chavez 6/13/76 aparece como esposo pero es el hermano gemelo. Cuando lo arrestaron el estaba con los documentos del hermano y lo arrestaron y vino al programa con el nombre del hermano gemelo. Su verdareo nombre es Medardo Chavez.

Media Authoritation

NO DOY PERMISO

DOY PERMISO

Limitado Impresos

Limitado Educativo

Limitado CL

Intake: J. Manzo
Data Entry: D. Gomez
Referred By