MED-MAR-74

Code
MED-MAR-74
Mercy ID
V-02106-01
Encounter Date
12/07/2005
Last
Medina
First
Maria del carmen
DOB
10/11/1974
County
Gwinnett
Street
1403 Hunter Ridge
City
Norcross
State
GA
Zip
30092-
Home
(678) 368-5639
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Lozano
First
Dario
DOB
03/09/1972
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
YES
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
Daniel Lozano 11/19/2002 Mother GA/USA
Edgar Paredes 10/10/1994 Mother Mexico
Erik Paredes 06/24/1993 Mother Mexico
Stephanie Lozano 01/22/1999 Mother GA/USA
NOTES

Media Authoritation

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