MUS-SHA-73

Code
MUS-SHA-73
Mercy ID
V-02571-01
Encounter Date
08/06/2007
Last
Mustafa
First
Shannon
DOB
02/08/1973
County
Dekalb
Street
4499 Lawrenceville Hwy
City
Tucker
State
GA
Zip
30084-
Home
(770) 820-3090
Cell
(678) 334-9597
Family Status
Adult couple-no children
COB
USA
Gender
Female
Housing
Single Family
Education Level
College Degree

Spouse Information

Last
Bustamante
First
William
DOB
12/22/1983
Address
N/A
Telephone
(770) 820-3106
COB
Honduras
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Shannon P 12/01/1990 Father Miami/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By