LOP-MAA-63

Code
LOP-MAA-63
Mercy ID
V-02567-01
Encounter Date
08/15/2007
Last
Lopez
First
Maria teresa
DOB
03/17/1963
County
Dekalb
Street
3568 Old Chamblee Rd. #-8
City
Chamblee
State
GA
Zip
30340-
Cell
(770) 621-0656
Work
(404) 399-8121
Family Status
Single parent w/children
COB
Chile
Gender
Female
Housing
Not Homeless
Education Level
High school graduate

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
YES

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
Marcela Baeza 09/07/1991 Mother GA/USA

Former Spouse 1 Information

Last
Baeza
First
Edgardo
DOB
10/31/1963
Telephone
N/A
COB
Chile
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