LOP-GLO-56

Code
LOP-GLO-56
Mercy ID
V-03025-01
Encounter Date
03/10/2009
Last
Lopez
First
Gloria
DOB
01/04/1956
County
Gwinnett
Street
4182 Vowers Pointe Dr.
City
Lilburn
State
GA
Zip
30047-
Cell
(678) 558-8980
Family Status
Single adult
COB
Colombia
Gender
Female
Housing
Doubling Up
Education Level
Some College

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

Former Spouse 1 Information

Last
Romero
First
Gustavo
DOB
03/21/1953
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
J. Perez
Data Entry
J. Manzo
Referred By
Amiga-San Patricia info