ANT-MAR-66

Code
ANT-MAR-66
Mercy ID
V-00133-02
Encounter Date
02/16/2000
Last
Antonio
First
Marcos
DOB
03/04/1966
County
Dekalb
Street
3450 Evans Rd Ad103 B
City
Chamblee
State
GA
Zip
30341-
Home
(770) 493-7661
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Jimenez
First
Bernarda
DOB
N/A
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
R. Miranda
Data Entry
D. Gomez
Referred By