GOM-CRI-72

Code
GOM-CRI-72
Mercy ID
V-01404-01
Encounter Date
10/30/2003
Last
Gomez
First
Cristina
DOB
07/26/1972
County
Gwinnett
Street
3444 Warmich Way
City
Snellville
State
GA
Zip
30039-
Home
(770) 310-9313
Family Status
Two parent family w/children
COB
Guatemala
Gender
Female
Housing
Not Homeless
Education Level
Vocational/Technical

Spouse Information

Last
Gomez
First
Gabino
DOB
01/25/1963
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
No
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
Joshua Gomez 02/20/1998 Mother GA/USA
Julissa Gomez 09/30/1995 Mother GA/USA
Rafael Gomez 11/02/1991 Mother 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
x3737 Damaryz