CID-VER-76

Code
CID-VER-76
Mercy ID
V-02026-01
Encounter Date
09/13/2005
Last
Cid
First
Veronica
DOB
04/01/1976
County
Dekalb
Street
3559 Pleasant Brook Village Lane
City
Doraville
State
GA
Zip
30340-
Home
(678) 534-1297
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Gaytan
First
Jorge
DOB
11/28/1977
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
YES
Consentimiento De Participar
YES

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
Alex Gaytan 10/23/2003 Parents GA/USA
Erik Gaytan 01/01/2008 Parents 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