PER-ROS-77

Code
PER-ROS-77
Mercy ID
V-01945-01
Encounter Date
06/10/2005
Last
Perez hernandez
First
Rosa maria
DOB
04/06/1977
County
Cobb
Street
760 Mableton Parkway Lt. 10 A
City
Mableton
State
GA
Zip
30126-
Home
(678) 886-4637
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Hernandez
First
Julio cesar
DOB
08/31/1973
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
YES
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
Alfonso Hernandez 04/23/2000 Parents GA/USA
Hector Hernandez 03/05/2001 Parents GA/USA
Julio Cesar Hernendez 09/11/1998 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
Llamo a la linea de Juana