PET-ANA-76

Code
PET-ANA-76
Mercy ID
V-00240-01
Encounter Date
06/20/2000
Last
Petatan
First
Ana maria
DOB
05/23/1976
County
Fulton
Street
5320 Roswell Rd. H-4
City
Atlanta
State
GA
Zip
30342-
Home
(770) 572-7739
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Other
Education Level
Grade school

Spouse Information

Last
Gutierrez
First
Eliodoro
DOB
04/25/1970
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
damaly gutierrez 11/12/1992 Mother GA/USA
lesly gutierrez 12/06/1997 Grandparents 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
D. Gomez
Referred By