VAL-ANA-67

Code
VAL-ANA-67
Mercy ID
V-01029-01
Encounter Date
11/05/2002
Last
Valencia
First
Ana lucia
DOB
03/25/1967
County
Other
Street
702 Bell Court Parkway
City
Roswell
State
GA
Zip
30076-
Home
(687) 352-1870
Cell
(770) 617-9857
Family Status
Single parent w/children
COB
Colombia
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Gomez
First
Jairo
DOB
07/02/1958
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
No
Stranger
No
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
Felipe