CUY-BET-79

Code
CUY-BET-79
Mercy ID
V-02982-01
Encounter Date
01/08/2009
Last
Cuyan
First
Betsy
DOB
09/07/1979
County
Fulton
Street
725 Wood Creak Way
City
Roswell
State
GA
Zip
30076-
Home
(770) 640-1388
Family Status
Single adult
COB
USA
Gender
Female
Housing
Doubling Up
Education Level
Some College

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
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
Grace Cowell 05/01/2008 Father GA/USA
Shoawn Cowell 10/12/2005 Father GA/USA

Former Spouse 1 Information

Last
Cowell
First
John
DOB
09/26/1976
Telephone
N/A
COB
N/A
Home Owner
YES
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
linea-Juana