GOM-SIL-67

Code
GOM-SIL-67
Mercy ID
V-02355-01
Encounter Date
10/17/2006
Last
Gomez
First
Silvia
DOB
08/05/1967
County
Gwinnett
Street
1850 Sprinkwood
City
Norcross
State
GA
Zip
30341-
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Profundo
First
Idelfonzo
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
No
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
Aileen Vazquez 01/11/1990 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Vazquez
First
Miguel
DOB
N/A
Telephone
N/A
COB
Mexicano
Home Owner
No
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