MEN-ROS-05

Code
MEN-ROS-05
Mercy ID
V-02147-01
Encounter Date
01/04/2006
Last
Mendoza
First
Rosa maria
DOB
05/07/1965
County
Dekalb
Street
2505 Vanfleet Circle
City
Doraville
State
GA
Zip
30360-
Home
(770) 452-8198
Other
(678) 499-4919
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Ramirez
First
Apolonio
DOB
09/17/1961
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
Jose Ramirez 07/02/1994 Parents GA/USA
Susana Ramirez 08/08/1985 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
R. Gonzalez
Referred By
Felipe Perez