GUZ-SEV-78

Code
GUZ-SEV-78
Mercy ID
V-03270-02
Encounter Date
02/23/2010
Last
Guzman
First
Severo
DOB
10/16/1978
County
Fulton
Street
6558 Roswell Road 8-D
City
Sandy springs
State
GA
Zip
30328-
Cell
(404) 552-2162
Family Status
Single adult
COB
Mexico
Gender
Male
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
YES
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
YES
2
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
YES
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
Alexis David Guzman N/A Mother GA/USA
Daniel Guzman N/A Mother GA/USA
Kevin Yahir Guzman N/A Mother GA/USA

Former Spouse 1 Information

Last
Carmona
First
Leticia
DOB
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
J. Manzo
Referred By
linea-Juana/Fulton Cty