GOM-ORQ-69

Code
GOM-ORQ-69
Mercy ID
V-00322-01
Encounter Date
10/25/2000
Last
Gomez
First
Orquidia
DOB
07/18/1969
County
Gwinnett
Street
2120 Golden Valley Dr
City
Lawrenceville
State
GA
Zip
30341-
Home
(770) 962-6201
Cell
(678) 365-8909
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Vocational/Technical

Spouse Information

Last
Perez meza
First
Jorge
Middle
A.
DOB
06/06/1974
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Ali Guadalupe Perez Gomez 03/13/1998 Parents 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
Y. Garcia
Referred By