ROD-EVA-74

Code
ROD-EVA-74
Mercy ID
V-03136-01
Encounter Date
08/17/2009
Last
Rodriguez
First
Evangelina
DOB
02/07/1974
County
Cobb
Street
388 Phillips Dr.
City
Marietta
State
GA
Zip
30060-
Cell
(678) 663-7453
Family Status
Two parent family w/children
COB
USA
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Ramos
First
Leonardo
DOB
07/07/1983
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
YES

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

Former Spouse 1 Information

Last
Sanchez
First
Gustavo
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
YES
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