MOU-MAR-78

Code
MOU-MAR-78
Mercy ID
V-03057-01
Encounter Date
04/22/2009
Last
Morua
First
Maria
DOB
09/07/1978
County
Cobb
Street
2022 Galeria Lane
City
Smyrna
State
GA
Zip
30060-
Cell
(678) 791-9129
Work
(770) 432-0374
Family Status
Single adult
COB
Mexico
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
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
YES
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
Angel Rodriguez 01/05/2007 Mother GA/USA
Jesus R. Rodriguez 02/10/1998 Mother GA/USA
Luis A. Rodriguez 11/05/2006 Mother GA/USA

Former Spouse 1 Information

Last
Rodriguez
First
Adan
DOB
12/19/1966
Telephone
N/A
COB
N/A
Home Owner
No
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
clienta-walkin-Silvia Tarango