MAS-AME-36

Code
MAS-AME-36
Mercy ID
V-02898-01
Encounter Date
10/01/2008
Last
Masaguez
First
Teresa
DOB
12/05/1936
County
Forsyth
Street
7125 Jonesway
City
Cumming
State
GA
Zip
30041-
Cell
(404) 290-9919
Family Status
Single adult
COB
Uruguay
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Santa angelo
First
Juan
DOB
N/A
Address
N/A
Telephone
N/A
COB
Uruguay
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
YES
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
J. Manzo
Referred By
walk in