URB-JOS-79

Code
URB-JOS-79
Mercy ID
V-00777-02
Encounter Date
12/18/2001
Last
Urbina
First
Jose
DOB
11/01/1979
County
Dekalb
Street
504 Brook Ridge Ave.
City
Doraville
State
GA
Zip
30340-
Home
(678) 725-8896
Family Status
Adult coupie-no children
COB
Mexico
Gender
Male
Housing
Not Homeless
Education Level
Some College

Spouse Information

Last
Velasquez
First
Arcedalia
DOB
03/24/1980
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
F. Perez
Data Entry
K. Aleman
Referred By