TAP-MDR-69

Code
TAP-MDR-69
Mercy ID
V-00038-01
Encounter Date
01/19/2000
Last
Tapia
First
Maria del rocio
DOB
06/14/1969
County
Gwinnett
Street
P.O. Box 28
City
Lilburn
State
GA
Zip
30048-
Home
(404) 316-4013
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Romero
First
Carlos
DOB
01/20/1965
Address
unknown
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
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
Brenda Cruz 11/13/2000 Mother GA/USA
Eduardo Alberto Tapia 03/12/1991 Father GA/USA
Rocio Betzabeth Tapia 02/18/1989 Father GA/USA

Former Spouse 1 Information

Last
Tapia
First
Humberto
DOB
10/08/1960
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

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