AUS-AMB-81

Code
AUS-AMB-81
Mercy ID
V-02353-01
Encounter Date
10/23/2006
Last
Austen
First
Ambar
DOB
02/12/1981
County
Dekalb
Street
not given
City
Nodio
State
GA
Zip
00000-
Cell
(678) 549-1334
Family Status
Unknow/Unreported
COB
USA
Gender
Female

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
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

Former Spouse 1 Information

Last
Varela
First
Alfredo
DOB
01/12/1977
Telephone
N/A
COB
Mexicano
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
Felipe