GON-MAI-64

Code
GON-MAI-64
Mercy ID
V-03380-01
Encounter Date
08/02/2010
Last
Gonzalez
First
Maria de los angeles
DOB
11/22/1964
County
Fulton
Street
653 Lindberg Dr.
City
Atlanta
State
GA
Zip
30324-
Cell
(770) 374-7954
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Vocational/Technical

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
Francisco Escamilla 06/11/1987 Adulto/Soltero Mexico
Tanua Escamilla 02/14/1986 Adulto/Casado Mexico

Former Spouse 1 Information

Last
Green
First
Morris
DOB
12/19/1967
Telephone
N/A
COB
USA
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
linea-Juana/Asoc. Lati.-Silvia