SAN-YAS-03

Code
SAN-YAS-03
Mercy ID
V-03510-13
Encounter Date
02/23/2011
Last
Santana
First
Yasimi
DOB
01/13/2003
County
Fulton
Street
2400 Riverwood Ln. Apt. G
City
Roswell
State
GA
Zip
30075-
Cell
(404) 447-8167
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Single Family
Education Level
Grade school

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
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
NOTES

Media Authoritation

DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
Volunteer
Data Entry
J. Manzo
Referred By