KEA-ETH-55

Code
KEA-ETH-55
Mercy ID
V-00145-01
Encounter Date
03/22/2000
Last
Keasler
First
Ethel
DOB
07/31/1955
County
Cobb
Street
1660 Squire Dr
City
Mariette
State
GA
Zip
30008-
Home
(770) 435-3155
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Not Homeless
Education Level
Vocational/Technical

Spouse Information

Last
Keasler
First
Harvey
Middle
E.
DOB
03/18/1960
Address
same
Telephone
N/A
COB
EEUU
Home Owner
No
Driver
No
Home Owner
YES
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
Anwar Rodriguez 09/23/1981 Mother GA/USA
Ethel Rodriguez 02/22/1986 Mother GA/USA
Marjorie Rodriguez 02/09/1988 Mother GA/USA
Rony Rodriguez 08/02/1989 Mother 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
D. Gomez
Referred By