BLA-MOI-99

Code
BLA-MOI-99
Mercy ID
V-00582-21
Encounter Date
07/11/2001
Last
Blandon
First
Moises
DOB
04/30/1988
County
Dekalb
Street
3700 Bufod Hwy Apt. 63
City
Atlanta
State
GA
Zip
30329-
Home
(000) 000-0000
Family Status
Attached youth
COB
Nicaragua
Gender
Male Child
Housing
Not Homeless
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
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
K. Aleman
Data Entry
K. Aleman
Referred By