GUA-EVE-72

Code
GUA-EVE-72
Mercy ID
V-00019-01
Encounter Date
01/06/2000
Last
Guandique
First
Evelin
DOB
09/04/1972
County
Fulton
Street
265 Sabrina Ct.
City
Woodstock
State
GA
Zip
30188-
Home
(770) 575-1045
Family Status
Two parent family w/children
COB
El Salvador
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Bolaños
First
Alberto
DOB
06/07/1979
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Alan Bolaños 06/28/2001 Parents GA/USA
Joana Romero 03/20/1993 Mother w/Stepfather GA/USA
Lorena Romero 05/19/1995 Mother w/Stepfather GA/USA
Marcos A. Ramirez 10/13/1990 Mother w/Stepfather GA/USA
Monica Romero 09/23/1994 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Gomez
First
Raul
DOB
04/17/1965
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

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