SUA-MAR-72

Code
SUA-MAR-72
Mercy ID
V-01683-01
Encounter Date
08/19/2004
Last
Suarez
First
Maria de los a
DOB
03/18/1972
County
Fulton
Street
1348 Grand Creek
City
Roswell
State
GA
Zip
30076-
Home
(678) 365-7156
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Lopez
First
Gustavo
DOB
N/A
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
No
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
Geovany Lopez 06/09/2003 Mother GA/USA
Gustavo Lopez Jr. N/A Mother GA/USA
Juan Antonio Suarez 06/08/1989 Mother 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
K. Aleman
Referred By