GAM-ROS-58

Code
GAM-ROS-58
Mercy ID
V-02577-01
Encounter Date
08/21/2007
Last
Gambettea
First
Rosa
DOB
03/04/1958
County
Cobb
Street
413 Left Trace
City
Marietta
State
GA
Zip
30064-
Cell
(678) 698-5867
Family Status
Single parent w/children
COB
Perú
Gender
Female
Housing
Not Homeless
Education Level
Post Grad Degree

Spouse Information

Last
Zapata
First
William
DOB
05/15/1959
Address
N/A
Telephone
N/A
COB
Perú
Home Owner
YES
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
YES
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
Desirete Zapata 01/31/1992 Mother 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
J. Manzo
Referred By
linea-Juana