LOP-IDO-82

Code
LOP-IDO-82
Mercy ID
V-01662-01
Encounter Date
07/16/2004
Last
Lopez
First
Idolina
DOB
04/15/1982
County
Clayton
Street
4663 Waldro Apt. A-7
City
Forest park
State
GA
Zip
30297-
Home
(404) 361-1039
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Adult, no formal education

Spouse Information

Last
Hernandez
First
Juan
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
Ashly Hernandez N/A Parents GA/USA
Blanca L. Hernandez N/A Parents GA/USA
Jonathan Hernandez N/A Parents GA/USA
Xitlaly Hernandez N/A Parents GA/USA

Former Spouse 1 Information

Last
Hernandez
First
Concepcion
DOB
10/19/1978
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

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
Jacqueline Cuadra