GAM-MAR-70

Code
GAM-MAR-70
Mercy ID
V-02834-01
Encounter Date
06/25/2008
Last
Gamboa
First
Maribel
DOB
09/15/1970
County
Cobb
Street
3095 Palomino Dr.
City
Power spring
State
GA
Zip
30127-
Home
(678) 402-5631
Cell
(678) 732-6206
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Gamboa
First
Jorge
DOB
03/16/1964
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
Deisy Gamboa 04/12/1992 Parents GA/USA
Ivan Gamboa 01/02/1990 Parents GA/USA
Jorge Gamboa 12/27/1994 Parents 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
J. Manzo
Referred By
walk in