BLA-GLO-51

Code
BLA-GLO-51
Mercy ID
V-01574-01
Encounter Date
04/20/2004
Last
Blakeslee mejia
First
Gloria
DOB
03/01/1951
County
Cobb
Street
5637 Rutland Dr.
City
Power spring
State
GA
Zip
30127-
Home
(678) 567-1835
Family Status
Adult coupie-no children
COB
Honduras
Gender
Female
Housing
Not Homeless
Education Level
Vocational/Technical

Spouse Information

Last
Blakeslee
First
Peter
DOB
11/15/1949
Address
N/A
Telephone
N/A
COB
EEUU
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
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
J. Manzo
Data Entry
K. Aleman
Referred By
C.S.C. x1375