MOS-DOR-76

Code
MOS-DOR-76
Mercy ID
V-02303-01
Encounter Date
08/17/2006
Last
Mosquera
First
Doris
DOB
08/11/1976
County
Gwinnett
Street
1375 Hines Creek
City
Grayson
State
GA
Zip
30017-
Cell
(678) 851-1703
Family Status
Two parent family w/children
COB
Colombia
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Rebolledo
First
Hector
DOB
12/05/1965
Address
N/A
Telephone
N/A
COB
Colombia
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
Juan Pablo Rebolledo 01/03/2003 Parents GA/USA
Kevin Rebolledo 05/29/2000 Grandparents Colombi
Sergio Rebolledo 11/13/1998 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
J. Manzo
Referred By