UPI-ROS-68

Code
UPI-ROS-68
Mercy ID
V-00518-01
Encounter Date
09/25/2002
Last
Upiachihua
First
Rosalmira
DOB
12/20/1968
County
Gwinnett
Street
1503 Buford Hwy S-3
City
Atlanta
State
GA
Zip
30392-
Home
(678) 886-2247
Family Status
Two parent family w/children
COB
Perú
Gender
Female
Housing
Not Homeless
Education Level
Vocational/Technical

Spouse Information

Last
Brock
First
Luis alberto
DOB
10/05/1962
Address
N/A
Telephone
N/A
COB
Perú
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Luis Alberto Brock 07/29/1989 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
x7764 Ma. Eugenia