SAM-RIT-75

Code
SAM-RIT-75
Mercy ID
V-01744-01
Encounter Date
11/05/2004
Last
Samano
First
Rita
DOB
06/09/1975
County
Fulton
Street
7000 Roswell Rd Apt 354
City
Roswell
State
GA
Zip
30328-
Home
(770) 698-9633
Cell
(404) 483-7451
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Martinez
First
Marco
Middle
A.
DOB
05/28/1972
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
YES
Consentimiento De Participar
YES

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
Ana Candy Martinez 09/25/1999 N/A GA/USA
Leticia Martinez 07/08/1995 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
1375 Damaryz