LPZ-LET-67

Code
LPZ-LET-67
Mercy ID
V-03243-01
Encounter Date
01/28/2010
Last
Lopez
First
Leticia
DOB
04/28/1967
County
Clayton
Street
624 Redfox Trail
City
Jonesboro
State
GA
Zip
30238-
Cell
(678) 683-5237
Work
(770) 292-8977
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high 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
YES
Consentimiento De Participar
YES

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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Diana Garcia 04/18/1984 Adulto/Soltero GA/USA
Erika M. Garcia 02/23/1995 Mother GA/USA
Mary Z. Garcia 10/13/1998 Mother GA/USA

Former Spouse 1 Information

Last
Garcia
First
Juan
DOB
10/02/1966
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
amiga-trabajo/Ma. Vargas