CIS-MAY-95

Code
CIS-MAY-95
Mercy ID
V-00463-11
Encounter Date
04/04/2001
Last
Cisneros
First
Mayra
DOB
02/01/1995
County
Dekalb
Street
4430 tilly mill rd apt 10d
City
Doraville
State
GA
Zip
30360-
Home
(678) 530-0634
Family Status
Attached youth
COB
Mexico
Gender
Female Child
Housing
Doubling Up
Education Level
Preschool

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
K. Aleman
Data Entry
S. Aviña
Referred By