MAR-CLA-61

Code
MAR-CLA-61
Mercy ID
V-01524-01
Encounter Date
03/12/2004
Last
Martinez
First
Claudia liliana
DOB
04/23/1961
County
Fulton
Street
4004 Lexington Farm Dr.
City
Alpharetta
State
GA
Zip
30004-
Home
(000) 000-0000
Cell
(404) 510-0186
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
College Degree

Spouse Information

Last
Bautista
First
Antonio
DOB
06/26/1964
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
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
xAngelica Family Ties