ROD-ILS-77

Code
ROD-ILS-77
Mercy ID
V-02436-01
Encounter Date
03/12/2007
Last
Rodriguez
First
Ilsy
DOB
11/24/1977
County
Gwinnett
Street
6234 Forest Valley k-5
City
Norcoss
State
GA
Zip
30093-
Home
(678) 380-3922
Family Status
Two parent family w/children
COB
Guatemala
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Reyes
First
Edy
DOB
10/07/1975
Address
N/A
Telephone
(678) 770-2912
COB
Guatemala
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
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
Eric Reyes 10/25/2005 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
C. Martinez
Referred By
Linea-Juana