GUZ-ALB-79

Code
GUZ-ALB-79
Mercy ID
V-03508-01
Encounter Date
02/23/2011
Last
Guzman
First
Alba
DOB
09/27/1979
County
Gwinnett
Street
1363 Wingfoot Way
City
Norcross
State
GA
Zip
30043-
Cell
(404) 934-4866
Family Status
Single adult
COB
El Salvador
Gender
Female
Housing
Doubling Up
Education Level
High school graduate

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
YES
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
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
Edwin Calles 02/19/2000 Father GA/USA
Jonathan Calles 02/28/2007 Father GA/USA
Keiri Calles 04/18/2010 Father GA/USA

Former Spouse 1 Information

Last
Calles
First
Leandro
DOB
02/27/1981
Telephone
N/A
COB
El Salvador
Home Owner
YES
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
Ma. Rosario Navas