LOP-MAT-72

Code
LOP-MAT-72
Mercy ID
V-02882-01
Encounter Date
08/15/2008
Last
Lopez
First
Martha
DOB
03/21/1972
County
Dekalb
Street
5601 Chamblee Tucker Road A-18
City
Chamblee
State
GA
Zip
30340-
Cell
(678) 552-2224
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

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
No
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Antonio Juarez 08/03/2000 Mother GA/USA
Miguel Juarez 07/21/2005 Mother GA/USA
Sirenia Olmos 05/18/1990 Grandmother Mexico-Materna

Former Spouse 1 Information

Last
Juarez
First
Antonio
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
YES
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