MAT-GEL-81

Code
MAT-GEL-81
Mercy ID
V-00741-01
Encounter Date
11/07/2001
Last
Matias
First
Gelacia
DOB
07/05/1981
County
Dekalb
Street
2951 N. Dekalb Dr. # 205
City
Doraville
State
GA
Zip
30340-
Home
(678) 791-3217
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Preschool

Spouse Information

Last
Lopez
First
Edgar
DOB
01/22/1981
Address
N/A
Telephone
N/A
COB
Guatemala
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
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
John Lopez 09/19/2006 Parents GA/USA
Jorge (Larry) Crisantos 07/13/2001 Mother w/Stepfather GA/USA
Karen Lopez 07/11/2003 Parents GA/USA

Former Spouse 1 Information

Last
Crisanto
First
Apolinar
DOB
01/22/1981
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
G. Landeros
Data Entry
K. Aleman
Referred By