CAM-RAF-62

Code
CAM-RAF-62
Mercy ID
V-00011-01
Encounter Date
01/05/2000
Last
Camacho
First
Rafaela
DOB
02/06/1962
County
Gwinnett
Street
1312 stoney Brook rd
City
Tucker
State
GA
Zip
30084-
Home
(770) 496-4558
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Ramirez
First
Ernesto
DOB
03/06/1970
Address
same
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
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
Carla Ramirez 08/12/1988 Parents GA/USA
Ernesto Ramirez 05/12/1993 Parents GA/USA
Jaime Ramirez 09/10/1995 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
D. Gomez
Referred By