IXC-LID-77

Code
IXC-LID-77
Mercy ID
V-02261-01
Encounter Date
05/31/2006
Last
Ixchop
First
Lidia
DOB
10/10/1977
County
Gwinnett
Street
Gwinnett Square Apt #1202
City
Duluth
State
GA
Zip
00000-
Home
(770) 256-4277
Cell
(678) 933-9084
Family Status
Single adult
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
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
Darlen Yamaleth Ixchop N/A Grandmother Guatemala
Jeffrey Ixchop N/A Grandmother Guatemala
Kevin Ixchop N/A Grandmother Guatemala
Meyby Ixchop N/A Grandmother Guatemala
Yasmin Ixchop 08/28/1992 Grandmother Guatemala
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