BAI-XEN-81

Code
BAI-XEN-81
Mercy ID
V-02998-01
Encounter Date
02/06/2009
Last
Baires
First
Xenia
DOB
01/29/1981
County
Gwinnett
Street
1355 Graves Apt. B
City
Norcross
State
GA
Zip
30095-
Cell
(404) 200-8757
Family Status
Two parent family w/children
COB
El Salvador
Gender
Female
Housing
Doubling Up
Education Level
Adult, no formal education

Spouse Information

Last
Larin
First
Nelson
DOB
05/13/1973
Address
N/A
Telephone
N/A
COB
El Salvador
Home Owner
YES
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
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Alexis Baires 01/26/1996 Grandparents Maternos
Ashly Larin 05/28/2008 Parents GA/USA
Jansy Larin 07/24/2003 Parents GA/USA
Nelson Larin 04/02/2002 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
Ma. Rosario Navas