ROD-CLA-73

Code
ROD-CLA-73
Mercy ID
V-03011-01
Encounter Date
02/20/2009
Last
Rodriguez
First
Claudia
DOB
12/27/1973
County
Cobb
Street
835 Powerspring St.
City
Smyrna
State
GA
Zip
30080-
Cell
(678) 933-9821
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Chavira
First
Roberto
DOB
04/17/1979
Address
N/A
Telephone
N/A
COB
USA
Home Owner
YES
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
Josue Chavira 07/17/2008 Parents GA/USA
Roberto Chavira Jr. 07/23/2006 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
linea-Clinica de la Mama-Cobb