MEN-ROS-65

Code
MEN-ROS-65
Mercy ID
V-01954-01
Encounter Date
06/29/2005
Last
Mendoza
First
Rosa
DOB
08/30/1965
County
Dekalb
Street
Not given
City
Not given
State
GA
Zip
00000-000
Home
(000) 000-0000
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Shelter
Education Level
Grade school

Spouse Information

Last
Reza
First
Francisco
DOB
04/17/1969
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Fernando Reza 06/11/1996 DFACS GA/USA
Francisco reza 04/21/1995 DFACS GA/USA
Layali Reza 04/19/1990 DFACS N/A
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
K. Aleman
Referred By