RIV-HEC-75

Code
RIV-HEC-75
Mercy ID
V-02625-02
Encounter Date
10/30/2007
Last
Rivera
First
Hector
DOB
01/31/1975
County
Fayette
Street
124 Westmount Way
City
Tyron
State
GA
Zip
30290-
Cell
(770) 656-1833
Family Status
Two parent family w/children
COB
Puerto Rico
Gender
Male
Housing
Not Homeless
Education Level
College Degree

Spouse Information

Last
Burgos
First
Monica
DOB
02/02/1976
Address
N/A
Telephone
N/A
COB
Puerto Rico
Home Owner
YES
Driver
No
Home Owner
YES
SOLO
No
Court Mandated
YES
Program Completed
YES
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
David Rivera 09/21/2004 Parents GA/USA
Leira Rivera 03/09/2006 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
J. Manzo
Referred By
Padre Hernan