BAZ-MAR-75

Code
BAZ-MAR-75
Mercy ID
V-01279-01
Encounter Date
07/11/2003
Last
Bazan
First
Maria renata
DOB
05/04/1975
County
Gwinnett
Street
65 W Mocking Bird Ln.
City
Lawrenceville
State
GA
Zip
30044-
Home
(770) 256-6218
Family Status
Single parent w/children
COB
Perú
Gender
Female
Housing
Not Homeless
Education Level
Vocational/Technical

Spouse Information

Last
Muños
First
Joel
DOB
11/11/1971
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
YES
Consentimiento De Participar
YES

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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Xitlaly Muños 08/14/2002 N/A GA/USA
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
x3737 Damaryz