GAL-NAT-79

Code
GAL-NAT-79
Mercy ID
V-02087-01
Encounter Date
11/04/2005
Last
Gallegos
First
Natali
DOB
04/07/1979
County
Douglass
Street
not given
City
Canton
State
GA
Zip
30155-
Home
(770) 489-7145
Other
(770) 489-7145
Family Status
Single parent w/children
COB
Ecuador
Gender
Female
Housing
Not Homeless
Education Level
Other

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
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
Melany Gallegos 12/31/1999 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
R. Gonzalez
Referred By