SAL-CIN-58

Code
SAL-CIN-58
Mercy ID
V-01071-01
Encounter Date
12/12/2002
Last
Salaz
First
Cindy
DOB
12/23/1958
County
Cobb
Street
254 Clave Dr. 19
City
Marietta
State
GA
Zip
30060-
Home
(770) 792-4438
Family Status
Adult coupie-no children
COB
USA
Gender
Female
Housing
Not Homeless
Education Level
Some College

Spouse Information

Last
Salas
First
Rony
DOB
N/A
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
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
YES
Stranger
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
Rafael/Evaluacion