JAI-GUA-80

Code
JAI-GUA-80
Mercy ID
V-02585-01
Encounter Date
09/01/2007
Last
Jaime
First
Guadalupe
DOB
03/15/1980
County
Gwinnett
Street
6204 Forest Valley
City
Norcross
State
GA
Zip
30093-
Cell
(404) 554-7136
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Olmos
First
Andres
DOB
11/25/1978
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
YES
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
Andres Nicolas Olmos 08/27/2005 Parents GA/USA
Juan Jose Ayala 09/26/2001 Mother w/Stepfather GA/USA
Roberto Carlos Olmos 01/24/2007 Parents GA/USA

Former Spouse 1 Information

Last
Ayala
First
Juan
DOB
07/07/1980
Telephone
N/A
COB
Mexico TPO
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