LOP-CLA-76

Code
LOP-CLA-76
Mercy ID
V-02040-01
Encounter Date
09/19/2005
Last
Lopez
First
Claudia
DOB
03/16/1976
County
Gwinnett
Street
3410 Talisade Lake Dr.
City
Duluth
State
GA
Zip
30096-
Home
(770) 495-5090
Family Status
Single parent w/children
COB
El Salvador
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Lopez
First
Neri
DOB
07/24/1969
Address
N/A
Telephone
N/A
COB
El Salvador
Home Owner
YES
Driver
No
Home Owner
YES
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
No

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
Maria Lopez 01/16/1997 Mother GA/USA
Neida Lopez 07/15/1995 Mother GA/USA
Xiomara Lopez 09/16/1993 Mother el salvador
NOTES

Media Authoritation

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