AMA-MAR-64

Code
AMA-MAR-64
Mercy ID
B-00024-01
Encounter Date
07/20/1964
Last
Amaya
First
Maria
DOB
07/20/1964
County
Clayton
Street
928 Dearing St.
City
Forest park
State
GA
Zip
30297-
Home
(404) 363-2477
Family Status
Adult coupie-no children
COB
Mexico
Gender
Female
Housing
Other
Education Level
Other

Spouse Information

Last
Aguilar
First
Manuel
DOB
N/A
Address
N/A
Telephone
N/A
COB
El Salvador
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
No
Consentimiento De Participar
No

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
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