CAR-EMI-82

Code
CAR-EMI-82
Mercy ID
V-03298-01
Encounter Date
04/12/2010
Last
Carbajal
First
Emilia
DOB
06/18/1982
County
Gwinnett
Street
955 Worcester Place
City
Lilburn
State
GA
Zip
30047-
Cell
(678) 630-4747
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
H.S. equivalency diploma

Spouse Information

Last
Macias
First
Francisco
DOB
06/02/1974
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
Efrain Carbajal 09/27/2002 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Cortes
First
Miguel
DOB
N/A
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
Amiga-Luz Pinzon