SIL-GLA-71

Code
SIL-GLA-71
Mercy ID
V-01957-01
Encounter Date
07/12/2005
Last
Siles
First
Gladis
DOB
02/02/1971
County
Gwinnett
Street
1647 Eric Cr.
City
Lawrenceville
State
GA
Zip
30043-
Home
(678) 368-8112
Family Status
Adult coupie-no children
COB
Perú
Gender
Female
Housing
Doubling Up
Education Level
College Degree

Spouse Information

Last
Mendoza
First
Rolando
DOB
06/28/1971
Address
N/A
Telephone
N/A
COB
Perú
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
NOTES

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