GOM-MAY-75

Code
GOM-MAY-75
Mercy ID
V-00421-01
Encounter Date
02/26/2001
Last
Gomez
First
Mayra
DOB
10/17/1975
County
Dekalb
Street
4969 central dr apt 204-a
City
Stone mountain
State
GA
Zip
30083-
Home
(770) 441-7642
Family Status
Two parent family w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Cervantes
First
Sergio
DOB
10/07/1967
Address
N/A
Telephone
N/A
COB
Guatemala
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
antonio alexis gomez cervantez 10/21/1999 Parents GA/USA
yoselenia gomez cervantes 04/17/1998 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
S. Aviña
Referred By
7764 michael roman