LOP-MAR-64

Code
LOP-MAR-64
Mercy ID
V-01286-01
Encounter Date
07/15/2003
Last
Lopez
First
Martha
DOB
12/08/1964
County
Dekalb
Street
2933 North Dekalb Dr.
City
Doraville
State
GA
Zip
30340-
Home
(770) 458-9116
Cell
(404) 488-9065
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Lopez
First
Carlos
DOB
01/31/1961
Address
N/A
Telephone
N/A
COB
El Salvador
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
Carlos Eduardo Lopez 06/12/1990 Parents GA/USA
Erick Lopez 09/25/1996 Parents GA/USA
Gabriel Lopez 03/23/1994 Parents GA/USA
Jessenia Carolina Lopez 07/20/1985 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
Walk-in/amiga Johana