MED-JOS-02

Code
MED-JOS-02
Mercy ID
V-03336-02
Encounter Date
05/25/2010
Last
Mederos
First
Jose
DOB
06/25/1984
County
Gwinnett
Street
4225 Janet Ct.
City
Lilburn
State
GA
Zip
30047-
Cell
(678) 698-6526
Family Status
Single adult
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
Vocational/Technical

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
NOTES

Media Authoritation

DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
J. Manzo
Referred By
Yanin Ceja & linea-Juana