LOZ-FRA-67

Code
LOZ-FRA-67
Mercy ID
V-02440-01
Encounter Date
03/23/2007
Last
Lozano
First
Francia
DOB
04/17/1967
County
Fulton
Street
2540 Greenwood Cr.
City
East point
State
GA
Zip
30344-
Cell
(678) 683-7550
Family Status
Two parent family w/children
COB
Colombia
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Flores
First
Margarito
DOB
10/17/1969
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
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
No
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Former Spouse 1 Information

Last
Molina
First
N/A
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
Linea-Juana