DEL-MAR-64

Code
DEL-MAR-64
Mercy ID
V-03271-01
Encounter Date
02/25/2010
Last
De la rosa
First
Maria
DOB
01/01/1964
County
Clayton
Street
9 Marlett Lane
City
Riverdale
State
GA
Zip
30296-
Cell
(678) 949-6721
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Adult, no formal education

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
YES
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
YES
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
Omar Molina 12/14/2000 Mother GA/USA
Sergio Molina 01/02/1996 Mother GA/USA

Former Spouse 1 Information

Last
Molina
First
Willian
DOB
N/A
Telephone
N/A
COB
El Salvador
Home Owner
YES
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Juana