GOM-MAR-78

Code
GOM-MAR-78
Mercy ID
V-01612-01
Encounter Date
05/28/2004
Last
Gomez
First
Maricela
DOB
09/26/1978
County
Fulton
Street
340 Misty Lane
City
Roswell
State
GA
Zip
00000-0000
Home
(678) 887-3416
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Gomez
First
Arnulfo
DOB
N/A
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
Arnulfo Gomez N/A Parents GA/USA
Blanca Gomez 07/12/1997 Parents GA/USA
Jaime Gomez 01/18/2000 Parents GA/USA
Omaro Gomez 02/03/1994 Parents GA/USA
Rosalio Gomez 10/18/1995 Parents GA/USA
Rosana Gomez 01/18/2003 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
Family First