LOZ-ROM-82

Code
LOZ-ROM-82
Mercy ID
V-02096-01
Encounter Date
10/13/2005
Last
Lozano
First
Romina
DOB
11/04/1982
County
Fulton
Street
No sabe
City
Lilburn
State
GA
Zip
30340-
Cell
(678) 851-8056
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Transitional
Education Level
Grade school

Spouse Information

Last
Adame
First
Angel
DOB
09/18/1981
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
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
Angel Adame 07/10/2002 Mother GA/USA
Jose Luis Adame 05/28/2004 Mother GA/USA
Samara Adame 07/13/1999 Grandmother Mexico
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