GOM-AMP-58

Code
GOM-AMP-58
Mercy ID
V-03161-01
Encounter Date
09/16/2009
Last
Gomez
First
Amparo ii
DOB
10/09/1958
County
Dekalb
Street
3506 Buford Hwy
City
Atlanta
State
GA
Zip
30329-
Cell
(404) 246-4333
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Vocational/Technical

Spouse Information

Last
Vasquez
First
Cresencio
DOB
05/05/1977
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
Ivonne Vasquez 02/09/2007 Parents GA/USA
Wendy Campos 11/14/1987 Adulto/Soltero GA/USA
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
Walkin