LOP-MAR-16

Code
LOP-MAR-16
Mercy ID
V-02040-11
Encounter Date
09/28/2005
Last
Lopez
First
Maria
DOB
01/16/1997
County
Gwinnett
Street
3410 Palisdale Lake Dr
City
Duluth
State
GA
Zip
30096-
Family Status
Attached youth
COB
Mexico
Gender
Female Child
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
There is another child w/the same code of lop-mar-97. Used to day of d.o.b. as the new code for this child.

Media Authoritation

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