VAS-PAT-77

Code
VAS-PAT-77
Mercy ID
V-01258-01
Encounter Date
08/01/2003
Last
Vasquez
First
Patricia
DOB
02/23/1977
County
Clayton
Street
600 Valley Hill Rd. Apt B
City
Riverdale
State
GA
Zip
00000-0000
Home
(678) 358-1763
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up

Spouse Information

Last
Santos
First
Mario
DOB
N/A
Address
N/A
Telephone
N/A
COB
Honduras
Home Owner
YES
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Jonathan Martinez 12/16/1998 Mother GA/USA
Noel Santos 05/28/1993 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
x3737 Damaryz