PER-ROS-71

Code
PER-ROS-71
Mercy ID
V-01273-01
Encounter Date
07/07/2003
Last
Perez
First
Rosa maria
DOB
04/28/1971
County
Hall
Street
607 Dye Dr.
City
Gainsville
State
GA
Zip
30501-
Home
(678) 398-5294
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Rodriguez
First
Omar
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
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
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
Alexis Ivan Perez 10/18/1999 N/A GA/USA
Nadia Isabel Rodriguez N/A N/A GA/USA
Omar Alejandro Rodriguez 10/29/2001 N/A 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
x3737 Damaryz