HEN-DIA-61

Code
HEN-DIA-61
Mercy ID
V-01925-01
Encounter Date
05/24/2005
Last
Henry
First
Diana
DOB
10/17/1961
County
Fulton
Street
3211 Hope St.
City
Hapeville
State
GA
Zip
30354-
Home
(770) 960-6116
Cell
(770) 324-8741
Family Status
Single adult
COB
Colombia
Gender
Female
Housing
Not Homeless
Education Level
Some College

Spouse Information

Last
Henry
First
Kim
DOB
04/03/1955
Address
N/A
Telephone
N/A
COB
USA
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
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