CAM-PAT-63

Code
CAM-PAT-63
Mercy ID
V-00039-02
Encounter Date
07/23/1999
Last
Campuzano
First
Patricio
DOB
03/17/1963
County
Fulton
Street
1190 Lowel Lane Apt. 1190
City
Roswell
State
GA
Zip
30076-
Home
(770) 518-6936
Family Status
Single parent w/children
COB
Mexico
Gender
Male
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Taboada
First
Rosa
DOB
01/04/1968
Address
N/A
Telephone
(770) 518-6936
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
YES
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
Fortino Taboada 06/03/1989 Mother GA/USA
Gloria Campuzano 07/26/1984 Parents GA/USA
Rosalina Campuzano 08/05/1986 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
F. Perez
Data Entry
S. Aviña
Referred By