ORT-BIB-73

Code
ORT-BIB-73
Mercy ID
V-02944-01
Encounter Date
11/17/2008
Last
Ortiz
First
Bibiana
DOB
03/09/1973
County
Gwinnett
Street
1305 Sugarwood Ln.
City
Norcross
State
GA
Zip
30093-
Cell
(404) 824-0390
Family Status
Two parent family w/children
COB
Colombia
Gender
Female
Housing
Single Family
Education Level
Post Grad Degree

Spouse Information

Last
Serstruycken
First
Leonardo
DOB
07/17/1964
Address
N/A
Telephone
N/A
COB
Holanda
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
G. Landeros
Data Entry
C. Collier
Referred By
linea-Griselda