MED-RUB-80

Code
MED-RUB-80
Mercy ID
V-02956-01
Encounter Date
12/04/2008
Last
Medel
First
Rubi
DOB
12/05/1980
County
Gwinnett
Street
2302 Lion Hill Dr.
City
Norcross
State
GA
Zip
30071-
Cell
(404) 549-0520
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
High school graduate

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
YES
Consentimiento De Participar
YES

Petitioner

TPO
No
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
Jorge F. Cruz 03/31/2007 Mother GA/USA
Yanira M. Cruz 08/24/2002 Mother GA/USA

Former Spouse 1 Information

Last
Cruz
First
Jorge
DOB
01/25/1977
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Griselda