LOP-ROS-62

Code
LOP-ROS-62
Mercy ID
V-01494-01
Encounter Date
02/17/2004
Last
Lopez
First
Rosemary
DOB
01/16/1962
County
Dekalb
Street
3126 Alston Dr.
City
Decatur
State
GA
Zip
30032-
Home
(999) 999-9999
Family Status
Single adult
COB
Mexico
Gender
Female

Spouse Information

Last
Lopez
First
Alfredo
DOB
12/10/1973
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
Her number is (678) 768-2844 but she does not wish to be contacted

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