FER-CON-71

Code
FER-CON-71
Mercy ID
V-00486-01
Encounter Date
05/08/2001
Last
Fernandez
First
Confesora
DOB
06/01/1971
County
Other
Street
000 Some Street
City
Some city
State
GA
Zip
00000-0000
Home
(404) 634-9604
Family Status
Adult coupie-no children
COB
Mexico
Gender
Female
Housing
Other
Education Level
Other

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
NOTES
This clients documents were burned in May2001therefore her information is incomplete.

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
don't know