COR-BAN-85

Code
COR-BAN-85
Mercy ID
V-03044-01
Encounter Date
04/10/2009
Last
Cordoba
First
Blanca
DOB
01/01/1985
County
Dekalb
Street
999 no la contactamos
City
Chamblee
State
GA
Zip
30341-
Cell
(678) 913-9866
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Other

Spouse Information

Last
Regalado
First
Alberto
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
YES
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
YES
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
Evelyn Juliette Chavez 06/23/2007 Mother GA/USA
Jesus Chavez 01/14/2003 Mother GA/USA

Former Spouse 1 Information

Last
Chavez
First
Jesus
DOB
02/01/1974
Telephone
N/A
COB
Mexico
Home Owner
YES
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
entrevista