POT-TAN-65

Code
POT-TAN-65
Mercy ID
V-02084-01
Encounter Date
11/09/2005
Last
Potra
First
Tania
DOB
07/21/1965
County
Gwinnett
Street
900 Legacipara Dr #1316
City
Lawrenceville
State
GA
Zip
30043-
Home
(770) 403-1678
Family Status
Single adult
COB
Ecuador
Gender
Female
Housing
Transitional
Education Level
High school graduate

Spouse Information

Last
Potra
First
Livio
DOB
N/A
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
No
Stranger
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
R. Gonzalez
Referred By