LOP-RAQ-69

Code
LOP-RAQ-69
Mercy ID
V-01956-01
Encounter Date
06/27/2005
Last
Lopez
First
Rachel
DOB
09/16/1969
County
Gwinnett
Street
1616 Lia Hills Dr.
City
Norcross
State
GA
Zip
30071-
Cell
(678) 663-0710
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Ramos
First
Maria
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
YES
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
YES
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 Santana 01/04/1988 N/A GA/USA
Manuel Santana 05/03/1994 Mother GA/USA
Roberto Santana 10/02/1991 Mother GA/USA
Vanesa Santana 05/19/1989 Adulto/Casado GA/USA
Victoria Santana 06/18/1990 Grandmother GA/USA
NOTES
Ramos, Maria is the mother

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
K. Aleman
Referred By