MAR-GUA-61

Code
MAR-GUA-61
Mercy ID
V-01460-01
Encounter Date
01/05/2004
Last
Martinez
First
Guadalupe
DOB
12/11/1961
County
Cobb
Street
1090 Grehham Rd.
City
Marietta
State
GA
Zip
30062-
Home
(770) 499-1161
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Gonzalez
First
Jorge
DOB
04/25/1969
Address
N/A
Telephone
N/A
COB
Mexico
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Angel Gonzalez 04/17/2002 Mother GA/USA
Arturo Gonzalez 04/15/1987 N/A Died in 2000 of brain cancer
Brenda Gonzalez 01/01/1993 Mother GA/USA
Erika Gonzalez 10/11/1995 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 12/29/03