NGU-TIS-90

Code
NGU-TIS-90
Mercy ID
V-03367-01
Encounter Date
07/21/2010
Last
Nguyen
First
Tissany
DOB
12/06/1990
County
Dekalb
Street
3814 Buford Hwy NE C-5
City
Atlanta
State
GA
Zip
30329-
Other
(404) 370-7675
Family Status
Single adult
COB
USA
Gender
Female
Housing
Doubling Up
Education Level
Grade school

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
YES
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
W/DFCS N/A N/A GA/USA

Former Spouse 1 Information

Last
Garcia
First
Abel
DOB
03/01/1988
Telephone
N/A
COB
Mexico
Home Owner
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
WRC