GOM-ADE-60

Code
GOM-ADE-60
Mercy ID
V-03079-01
Encounter Date
05/29/2009
Last
Gomez
First
Adelina
DOB
04/18/1960
County
Gwinnett
Street
1256 Indian Way # 1-F
City
Lilburn
State
GA
Zip
30047-
Cell
(770) 235-2987
Family Status
Single adult
COB
El Salvador
Gender
Female
Housing
Doubling Up
Education Level
Adult, no formal education

Spouse Information

Last
No lo quiso dar
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
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
YES
As A Child
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
No
Stranger
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- Griselda