MEJ-JAC-69

Code
MEJ-JAC-69
Mercy ID
V-00566-01
Encounter Date
06/22/2001
Last
Mejia
First
Jacqueline sandra
DOB
05/16/1969
County
Not given
Street
P.O. Box 3128
City
Stanford
State
CT
Zip
06905-9991
Home
(203) 357-8590
Family Status
Single parent w/children
COB
Dominican Rep
Gender
Female
Housing
Shelter
Education Level
some high school

Spouse Information

Last
Mejia
First
Pascual
DOB
05/14/1958
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
Roni Omar Mejia 02/25/1993 Mother GA/USA
NOTES

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
x7764 Rebecca