GAE-MAR-70

Code
GAE-MAR-70
Mercy ID
V-03300-01
Encounter Date
04/12/2010
Last
Gamez
First
Maria
DOB
01/03/1970
County
Cobb
Street
825 Horizont Ln.
City
Marietta
State
GA
Zip
30062-
Cell
(404) 496-0364
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
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
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Isabela Ballesteros 11/03/2003 Mother GA/USA
Luis Ballesteros 06/12/1999 Mother GA/USA
Richard Ballesteros 12/06/2006 Mother GA/USA

Former Spouse 1 Information

Last
Ballesteros
First
Jose
DOB
09/17/1963
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. Perez
Data Entry
J. Manzo
Referred By
Consulado de Mexico/Linea