MIR-RUF-69

Code
MIR-RUF-69
Mercy ID
V-03091-01
Encounter Date
06/03/2009
Last
Miranda
First
Rufina
DOB
09/26/1969
County
Dekalb
Street
2418 Dunwoody Crossing Apt. A
City
Atlanta
State
GA
Zip
30338-
Cell
(678) 368-2054
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Rojas
First
Jose
DOB
03/19/1970
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
Elizabeth Rojas 01/27/2007 Mother GA/USA
Jose Rojas 03/20/1996 Mother GA/USA
Luis Rojas 11/14/1991 Mother GA/USA
Rene Rojas 11/12/1992 Mother 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
Alex Villasana