VIA-JUA-02

Code
VIA-JUA-02
Mercy ID
V-03432-22
Encounter Date
09/29/2010
Last
Viazcan
First
Juan carlos
DOB
06/24/2002
County
Dekalb
Street
6800 north chain boulevard
City
Doraville
State
GA
Zip
30360-
Cell
(404) 566-1417
Family Status
Single parent w/children
COB
Mexico
Gender
Male Child
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
La escuela le mando medicamento para la hiperactividad, pero no los tomo

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
Volunteer
Data Entry
J. Manzo
Referred By