GAR-GUA-74

Code
GAR-GUA-74
Mercy ID
V-00466-01
Encounter Date
04/09/2001
Last
Duran
First
Maria guadalupe
DOB
09/12/1974
County
Dekalb
Street
1850 Tobey Rd.
City
Chamblee
State
GA
Zip
30341-
Home
(770) 837-2045
Cell
(770) 873-0242
Family Status
Single parent w/children
COB
Mexico
Gender
Female
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
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
YES
Consentimiento De Participar
YES

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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Jose Uriel Garcia 06/14/1997 Mother GA/USA
Jovany Garcia 04/12/1994 Mother GA/USA
Leonel Garcia 06/12/1996 Mother GA/USA

Former Spouse 1 Information

Last
Garcia
First
Jose
DOB
03/28/1971
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES
aka Garcia, guadalupe

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
x7764 Ma. Eugenia