AMA-PET-75

Code
AMA-PET-75
Mercy ID
V-02443-01
Encounter Date
03/26/2007
Last
Amaya
First
Petrona
DOB
08/22/1975
County
Gwinnett
Street
2367 Planters Court Dr.
City
Lawrenceville
State
GA
Zip
30044-
Cell
(770) 896-2808
Family Status
Single parent w/children
COB
El Salvador
Gender
Female
Housing
Transitional
Education Level
High school graduate

Spouse Information

Last
Velazquez
First
Andres
DOB
N/A
Address
N/A
Telephone
N/A
COB
El Salvador
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
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Andrea Velazquez 12/17/2000 Mother GA/USA
Kalsey Amaya 12/29/2003 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
Walk in