ROD-CAR-63

Code
ROD-CAR-63
Mercy ID
V-01812-01
Encounter Date
01/24/2005
Last
Rodriguez
First
Carmen
DOB
10/13/1963
County
Gwinnett
Street
7214 Woodiron Dr.
City
Duluth
State
GA
Zip
30097-
Home
(770) 814-4105
Family Status
Two parent family w/children
COB
Puerto Rico
Gender
Female
Housing
Not Homeless
Education Level
Other

Spouse Information

Last
Rodriguez
First
Saul
DOB
06/14/1960
Address
N/A
Telephone
N/A
COB
Other
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
Saul Rodriguez N/A N/A GA/USA
Veronica Rodriguez N/A 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
x1375 Damaryz