MON-IRM-71

Code
MON-IRM-71
Mercy ID
V-01015-01
Encounter Date
10/03/2002
Last
Monje
First
Irma
DOB
03/17/1971
County
Dekalb
Street
Peachtree Ind. Blv. 101
City
Doraville
State
GA
Zip
30360-
Home
(404) 396-8849
Cell
(404) 934-2512
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Rosales
First
Jose
DOB
06/27/1964
Address
N/A
Telephone
N/A
COB
Guatemala
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Ana Maria Cordoba N/A N/A Guatemala
Diana Rosales 12/09/1995 Mother GA/USA
Jacqueline Rosales 08/19/1993 Grandmother Guatemala
Jose Rosales 01/22/1998 Mother GA/USA
Oscar Rosales 06/28/1992 Grandmother Guatemala
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
Felipe/Mision Catolica/Dr. Cano in 2003