BEJ-ADR-67

Code
BEJ-ADR-67
Mercy ID
V-03193-01
Encounter Date
10/26/2009
Last
Bejarano
First
Adriana
DOB
02/11/1967
County
Fulton
Street
1820 Bell Court Parkway
City
Roswell
State
GA
Zip
30076-
Cell
(678) 668-5060
Family Status
Single parent w/children
COB
Bolivia
Gender
Female
Housing
Single Family
Education Level
High school graduate

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Laura Bejarano 01/11/2001 Mother GA/USA
Thiago Bejarano 08/27/2002 Mother GA/USA

Former Spouse 1 Information

Last
Bejarano
First
Hector
DOB
04/14/1968
Telephone
N/A
COB
Bolivia
Home Owner
No
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-Griselda