DOR-EDI-77

Code
DOR-EDI-77
Mercy ID
V-03474-01
Encounter Date
11/15/2010
Last
Dorantes
First
Edith
DOB
02/21/1977
County
Fulton
Street
6125 Northwood Dr.
City
Sandy springs
State
GA
Zip
30342-
Cell
(678) 876-6969
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Salazar
First
Israel
DOB
07/07/1980
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
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
Anayely Lopez 06/09/1999 Mother GA/USA
Jonathan Lopez 06/04/1997 Mother GA/USA
Oscar Lopez 12/07/1993 Grandmother Mexico-Materna
Soledad Lopez 12/25/1995 Grandmother Mexico-Paterna

Former Spouse 1 Information

Last
Lopez
First
Anibal
DOB
02/12/1973
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
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Griselda