GOM-GUA-65

Code
GOM-GUA-65
Mercy ID
V-02745-01
Encounter Date
03/26/2008
Last
Gomez
First
Guadalupe
DOB
07/01/1965
County
Fulton
Street
2780 Cleveland Ave. # 3
City
East point
State
GA
Zip
30344-
Cell
(678) 973-5977
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Flores
First
Antonio
DOB
08/19/1964
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
Alma Alicia Flores 01/31/1989 Parents GA/USA
Antonio Flores 03/17/1996 Parents GA/USA
Blanca Elena Flores 09/15/1993 Parents GA/USA
Claudia Faviola Flores 08/07/1999 Parents GA/USA
Maria Guadalupe Flores 03/04/1991 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-Griselda