GUT-AMA-64

Code
GUT-AMA-64
Mercy ID
V-02151-01
Encounter Date
01/31/2006
Last
Gutierrez
First
Amanda
DOB
11/13/1964
County
Gwinnett
Street
2584 Gwim Dr
City
Norcross
State
GA
Zip
30071-
Home
(770) 734-0623
Cell
(404) 247-7770
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Gutierrez
First
Rosendo
DOB
03/09/1964
Address
N/A
Telephone
N/A
COB
Mexico
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
Antonio Gutierrez 11/02/1990 Mother GA/USA
Juan Gutierrez 10/31/1984 Mother GA/USA
Julia Gutierrez 05/11/1997 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