BAS-KOR-63

Code
BAS-KOR-63
Mercy ID
V-01358-01
Encounter Date
09/26/2003
Last
Basto
First
Korin
DOB
12/11/1963
County
Gwinnett
Street
4890 Gold Main Dr.
City
Sugar hill
State
GA
Zip
30518-
Home
(770) 271-2705
Family Status
Adult coupie-no children
COB
Colombia
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Basto
First
Libardo
DOB
10/13/1962
Address
N/A
Telephone
N/A
COB
Colombia
Home Owner
YES
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. Manzo
Data Entry
K. Aleman
Referred By