BAE-VER-72

Code
BAE-VER-72
Mercy ID
B-00040-01
Encounter Date
06/16/1998
Last
Baeza
First
Veronia
DOB
01/24/1972
County
Dekalb
Street
3685 Shallowford Rd. Apt C
City
Doravilee
State
GA
Zip
30340-
Home
(000) 000-0000
Family Status
Adult coupie-no children
COB
Mexico
Gender
Female
Housing
Other
Education Level
Other

Spouse Information

Last
Perez
First
Nicolas
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

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By