GUT-ROC-79

Code
GUT-ROC-79
Mercy ID
V-02205-01
Encounter Date
03/22/2006
Last
Gutierrez
First
Rocio
DOB
08/12/1979
County
Gwinnett
Street
2606 Park Colony Dr
City
Norcross
State
GA
Zip
30093-
Home
(770) 491-0412
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Other

Spouse Information

Last
Diaz
First
Osvaldo
DOB
09/27/1973
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
YES
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Edwin Diaz 11/24/2002 Parents GA/USA
Jorge Diaz 04/24/1999 Parents GA/USA
Mirella Hernandez 03/12/1996 Grandmother GA/USA
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
Walk In