VAL-MAR-70

Code
VAL-MAR-70
Mercy ID
V-02816-01
Encounter Date
06/06/2008
Last
Valencia
First
Maria
DOB
08/05/1970
County
Gwinnett
Street
2725 Waterford Park Dr
City
Lawrenceville
State
GA
Zip
30044-
Cell
(404) 271-4259
Other
(678) 891-8770
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
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Miranda Gomez 07/29/1999 Father GA/USA
Mytzy Gomez 05/14/1990 Mother GA/USA
Sergio Gomez 09/22/1991 Father GA/USA

Former Spouse 1 Information

Last
Gomez
First
Sergio
DOB
09/19/1964
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
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Griselda