ART-AMA-98

Code
ART-AMA-98
Mercy ID
B-00009-01
Encounter Date
02/11/1998
Last
Artiaga
First
Amalia
DOB
07/10/1998
County
Dekalb
Street
2945 N. Dekalb Dr.
City
Doraville
State
GA
Zip
30340-
Home
(000) 000-0000
Family Status
Unknow/Unreported
COB
Mexico
Gender
Female Child
Housing
Other
Education Level
Vocational/Technical

Spouse Information

Last
Diaz
First
Javier
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
DOB is incorrect

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