HER-REY-64

Code
HER-REY-64
Mercy ID
V-01585-01
Encounter Date
05/05/2004
Last
Hernandez
First
Reyna
DOB
07/15/1966
County
Gwinnett
Street
235 Mountain Dr.
City
Stone mountain
State
GA
Zip
30087-
Home
(770) 498-2014
Cell
(678) 849-7053
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Gomez
First
Jose
DOB
01/05/1969
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
YES
Consentimiento De Participar
YES

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
Jose Antonio Gomez 06/02/1991 Parents GA/USA
Jose Gomez 03/19/1986 Adulto/Casado GA/USA
Juan D. Gomez 12/13/1997 Parents GA/USA
Tania Lizet Gomez 09/14/1992 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
x1375 Damaryz