BUS-ANA-59

Code
BUS-ANA-59
Mercy ID
B-00044-01
Encounter Date
10/19/1998
Last
Bustamante
First
Ana
DOB
02/21/1959
County
Dekalb
Street
7080 Northern Place Apt 40
City
Doraville
State
GA
Zip
30360-
Home
(770) 522-0960
Family Status
Unknow/Unreported
COB
Mexico
Gender
Female
Housing
Other
Education Level
Other

Spouse Information

Last
Bustamante
First
Johny
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Juan Antonio 04/28/1988 Parents GA/USA
Mable Cristina 10/20/1991 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By