GAY-MAR-78

Code
GAY-MAR-78
Mercy ID
V-02332-01
Encounter Date
09/26/2006
Last
Gaytan
First
Maria
DOB
11/18/1978
County
Cobb
Street
1613 Bridge Mill Dr. # K
City
Marietta
State
GA
Zip
30067-
Home
(678) 789-1476
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Preschool

Spouse Information

Last
Gutierrez
First
Amador
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
YES

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
Andy Gutierrez 04/08/2003 Parents GA/USA
David Gutierrez 10/05/1999 Parents GA/USA
Jonathan Gutierrez 11/02/2001 Parents 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
J. Manzo
Referred By
Linea-Juana