GOM-ADR-83

Code
GOM-ADR-83
Mercy ID
V-03421-01
Encounter Date
09/12/2010
Last
Gomez
First
Adriana
DOB
03/05/1983
County
Fulton
Street
4883 Roswell Road Apt. J-5
City
Atlanta
State
GA
Zip
30342-
Cell
(404) 729-9363
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Vocational/Technical

Spouse Information

Last
Gomez
First
Hector
DOB
12/12/1981
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
Angelina Girard 01/27/2001 Mother GA/USA
Hector Gomez 09/18/2007 Mother GA/USA
Naomi Gomez 07/22/2005 Mother GA/USA
Victoria Gomez 07/22/2005 Mother GA/USA
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
Neiva Ortiz