QUI-ELK-65

Code
QUI-ELK-65
Mercy ID
V-00387-01
Encounter Date
01/17/2001
Last
Quiroga andrade
First
Elka
DOB
07/10/1965
County
Dekalb
Street
2825 Northeast spress way
City
Atlanta
State
GA
Zip
30345-
Home
(404) 636-5907
Family Status
Single adult
COB
Perú
Gender
Female
Housing
Doubling Up
Education Level
Some College

Spouse Information

Last
Ladera
First
Susie
DOB
07/25/1962
Address
N/A
Telephone
N/A
COB
Perú
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
YES
Consentimiento De Participar
YES

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
adriana andrade 11/07/1988 Mother GA/USA
elka andrade 11/07/1988 Mother GA/USA
fabricio andrade 11/16/1993 Mother GA/USA
NOTES
formed signed before the fire so original might have been lost

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
D. Gomez
Referred By
7764 rebeca