ROM-EUL-79

Code
ROM-EUL-79
Mercy ID
V-01876-01
Encounter Date
04/08/2005
Last
Romero
First
Eulalia
DOB
02/12/1979
County
Gwinnett
Street
702 Winn Hollow Tr. Apt 8
City
Norcross
State
GA
Zip
30071-
Other
(404) 951-2612
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
N/A
First
N/A
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
YES
As A Child
YES
Relative
YES
Stranger
No
As An Adult
YES
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Ana Karen Romero 05/24/1995 Grandmother Mexico-Materna
Isabela Salazar 07/21/2001 Mother GA/USA
Luis Salazar 12/12/1999 Mother GA/USA

Former Spouse 1 Information

Last
Salazar
First
Fermin
DOB
08/09/1971
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

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