LOP-MAI-72

Code
LOP-MAI-72
Mercy ID
V-02813-01
Encounter Date
06/10/2008
Last
Lopez
First
Teresa
DOB
11/13/1972
County
Cobb
Street
574 Sybil Lane
City
Marietta
State
GA
Zip
30067-
Home
(770) 423-2288
Cell
(678) 488-8003
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
High school graduate

Spouse Information

Last
Ruiz de leon
First
Jorge
DOB
N/A
Address
N/A
Telephone
N/A
COB
USA
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
Jorge Ruiz de Leon 08/19/2005 Mother 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