MIL-ROS-74

Code
MIL-ROS-74
Mercy ID
V-03296-01
Encounter Date
04/05/2010
Last
Milian
First
Rosa
DOB
06/20/1974
County
Henry
Street
193 Toby Springs Lane
City
Mcdonal
State
GA
Zip
30253-
Cell
(404) 933-0346
Work
(770) 897-9243
Other
(770) 897-9795
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Shelter
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
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
Floridalma F. Solis Milian 04/16/2007 Mother GA/USA
Maria Angelica Solis Milian 05/01/2008 Mother GA/USA

Former Spouse 1 Information

Last
Solis
First
Timoteo
DOB
01/24/1971
Telephone
N/A
COB
Mexico
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
Amiga llamo a la linea