GUT-ANA-70

Code
GUT-ANA-70
Mercy ID
V-01963-01
Encounter Date
07/15/2005
Last
Gutierrez
First
Ana lilia
DOB
06/13/1970
County
Forsyth
Street
5110 Virginia Ave.
City
Cumming
State
GA
Zip
30041-
Home
(770) 374-0820
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
High school graduate

Spouse Information

Last
Sanchez
First
Jorge
DOB
07/26/1973
Address
N/A
Telephone
N/A
COB
Mexico
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
Jazmin Sanchez 05/27/1997 Mother GA/USA
Jorge Stefano Sanchez 09/30/1991 Mother GA/USA
Jovan Sanchez 05/06/1999 Mother GA/USA
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