LOP-JUA-98

Code
LOP-JUA-98
Mercy ID
V-00729-21
Encounter Date
05/24/2002
Last
Lopez
First
Juan carlos
DOB
04/27/1998
County
Fulton
Street
5801 Kingsport Apt.138
City
Atlanta
State
GA
Zip
30342-
Home
(404) 459-0956
Family Status
Attached youth
COB
Mexico
Gender
Male Child
Housing
Doubling Up
Education Level
Child, not in 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
This intake was done with information from the mothers' file because I couldn't get the mother on the phone and Juan Carlos has been coming the group so I needed the intake.

Media Authoritation

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