URB-MAR-71

Code
URB-MAR-71
Mercy ID
V-01016-01
Encounter Date
10/14/2002
Last
Urbaez
First
Maria
DOB
06/24/1971
County
Dekalb
Street
3106 Dupont Lane
City
Tucker
State
GA
Zip
30084-
Home
(770) 491-1217
Family Status
Two parent family w/children
COB
Venezuela
Gender
Female
Housing
Not Homeless
Education Level
College Degree

Spouse Information

Last
Urbaez
First
Rafael
DOB
07/22/1971
Address
N/A
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
Fernando Urbaez 04/03/2001 Parents GA/USA
Ricardo Urbaez 09/19/1994 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