VAL-GLO-70

Code
VAL-GLO-70
Mercy ID
V-01764-01
Encounter Date
11/22/2004
Last
Valencia
First
Gloria
DOB
03/27/1970
County
Dekalb
Street
3550 Pleasant Hill Rd. Apt 312
City
Duluth
State
GA
Zip
30096-
Cell
(770) 887-7446
Other
(678) 768-0556
Family Status
Two parent family w/children
COB
Colombia
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Valencia
First
Holmes
DOB
01/12/1965
Address
N/A
Telephone
N/A
COB
Colombia
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
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
Mateo Sebastian Valencia 11/03/2001 Parents GA/USA
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
Remedios Perez