CRU-YDA-78

Code
CRU-YDA-78
Mercy ID
V-03410-01
Encounter Date
08/31/2010
Last
Cruz
First
Ydalia
DOB
11/22/1978
County
Dekalb
Street
3683 Buford Hwy
City
Atlanta
State
GA
Zip
30329-
Cell
(678) 600-4242
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high 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
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
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
David Cruz 11/10/1998 Grandmother Mexico-Materna
Katia Vital 11/21/2000 Grandmother Mexico-Materna

Former Spouse 1 Information

Last
Paredes
First
Federico
DOB
02/29/1980
Telephone
N/A
COB
Mexico
Home Owner
No
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
linea-Juana