DEL-LAU-72

Code
DEL-LAU-72
Mercy ID
V-03007-01
Encounter Date
02/13/2009
Last
De la rosa
First
Laura
DOB
09/06/1972
County
Gwinnett
Street
1900 Glennclub Dr. # 602
City
Stone mountain
State
GA
Zip
30087-
Cell
(678) 887-2936
Family Status
Single parent w/children
COB
USA
Gender
Female
Housing
Single Family
Education Level
Grade school

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
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
Marco De la Rosa 10/05/2000 Mother GA/USA
Miguel De la Rosa 11/07/1995 Mother GA/USA

Former Spouse 1 Information

Last
Wrigth
First
Damalni
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
YES
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