GOM-ADR-54

Code
GOM-ADR-54
Mercy ID
V-03127-01
Encounter Date
07/30/2009
Last
Gomez
First
Adriana
DOB
05/10/1954
County
Fulton
Street
1115 Heards Ferry Dr. Rd.
City
Atlanta
State
GA
Zip
30328-
Cell
(678) 644-1127
Other
(770) 977-4101
Family Status
Two parent family w/children
COB
Colombia
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Gomez
First
German
DOB
09/17/1948
Address
N/A
Telephone
N/A
COB
Colombia
Home Owner
YES
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
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
J. Perez
Data Entry
J. Manzo
Referred By
linea-Juana