FIZ-MAR-58

Code
FIZ-MAR-58
Mercy ID
V-01050-01
Encounter Date
12/10/2002
Last
Fizouaty
First
Maria olga
DOB
11/28/1958
County
Cobb
Street
3014 Stuarf Rich
City
Acworth
State
GA
Zip
30101-
Home
(404) 932-1435
Family Status
Single parent w/children
COB
Colombia
Gender
Female
Housing
Not Homeless
Education Level
Vocational/Technical

Spouse Information

Last
Fizouaty
First
Itan
DOB
10/06/1969
Address
N/A
Telephone
N/A
COB
Other
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Shlomo Fizouaty 12/12/1995 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
x7764 Ma. Eugenia