LOP-ROS-86

Code
LOP-ROS-86
Mercy ID
V-03239-01
Encounter Date
01/25/2010
Last
Lopez
First
Rosa isela
DOB
10/27/1986
County
Dekalb
Street
3381 Cumberland Dr. Apt. D
City
Chamblee
State
GA
Zip
30341-
Cell
(678) 793-2610
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
Gabriela Vazquez Lopez 07/12/2005 Mother GA/USA
Jesus Vazques 06/12/2008 Mother GA/USA
Jose Vazquez 11/09/2006 Mother GA/USA

Former Spouse 1 Information

Last
Vazquez
First
Joselino
DOB
N/A
Telephone
N/A
COB
Mexico
Home Owner
No

Former Spouse 2 Information

Last
L?????????????????????????????
First
L?????????????????????????????
DOB
N/A
Telephone
N/A
COB
Guatemala
Home Owner
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
corte de decatur