ROD-RMA-75

Code
ROD-RMA-75
Mercy ID
V-03137-01
Encounter Date
08/10/2009
Last
Rodriguez
First
Maria juana
DOB
07/02/1975
County
Douglass
Street
2945 Mill Ct.
City
Douglssville
State
GA
Zip
30135-
Home
(770) 949-3188
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Rodriguez
First
Jose octavio
DOB
11/27/1967
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
Alex Rodriguez 01/11/2005 Parents GA/USA
Chabeli Rodriguez 03/16/2000 Parents GA/USA
Estephany 06/02/1997 Parents GA/USA
Jannett Rodriguez 04/29/1996 Parents GA/USA
Jimmy Rodriguez 04/28/1995 Parents GA/USA
Steven Rodriguez 05/27/2002 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
Jackie-El compa. Llamo al programa