MED-ROS-71

Code
MED-ROS-71
Mercy ID
V-02732-01
Encounter Date
03/19/2008
Last
Medina
First
Rosa
DOB
04/25/1971
County
Clayton
Street
18 Lakeview Dr.
City
Riverdale
State
GA
Zip
30296-
Home
(770) 477-7546
Family Status
Two parent family w/children
COB
Panamá
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Vasquez
First
Manuel
DOB
03/20/1980
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
Beatriz Pinto 06/26/1996 Parents GA/USA
Lliny Vasquez 02/20/2004 Mother w/Stepfather 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