CAN-GUA-58

Code
CAN-GUA-58
Mercy ID
V-00481-01
Encounter Date
06/25/2001
Last
Canedo
First
Guadalupe
DOB
06/27/1958
County
Dekalb
Street
2628 Boland Dr.
City
Atlanta
State
GA
Zip
30319-
Home
(404) 636-4698
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Gonzalez
First
Jose manuel
DOB
06/13/1968
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
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
Karla Aleman 02/24/1981 Mother w/Stepfather GA/USA
Manuel Gonzalez 12/27/1992 Parents GA/USA
Martha Gonzalez 10/06/1991 Parents GA/USA
NOTES
Signed consent form and promesa before the fire

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
Karla