HER-ROS-76

Code
HER-ROS-76
Mercy ID
V-02656-01
Encounter Date
11/26/2007
Last
Hernandez
First
Rosella
DOB
03/11/1976
County
Forsyth
Street
110 Park St.
City
Cummings
State
GA
Zip
30040-
Cell
(678) 914-4589
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
College Degree

Spouse Information

Last
Murillo
First
Jesus
DOB
06/26/1974
Address
N/A
Telephone
N/A
COB
Mexico
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
Hector Murillo 08/18/1999 Parents GA/USA
Jimena Murillo 11/25/1997 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
shelter