GOM-JOS-81

Code
GOM-JOS-81
Mercy ID
V-01627-02
Encounter Date
06/15/2004
Last
Gomez
First
Jose luis
DOB
03/11/1981
County
Fulton
Street
1722 Greyfield Lane Apt 1722
City
Atlanta
State
GA
Zip
30350-
Home
(404) 591-1612
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
High school graduate

Spouse Information

Last
Silva
First
Rosalia
Middle
07047
DOB
07/04/1974
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
YES
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
Liza Marie Gomez 05/09/2003 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
R. Miranda
Data Entry
K. Aleman
Referred By
fulton Damaryz