PED-SUS-85

Code
PED-SUS-85
Mercy ID
V-03433-01
Encounter Date
02/15/2011
Last
Pedro
First
Susana
DOB
08/11/1985
County
Dekalb
Street
3671 Shallowford Rd. # A
City
Doraville
State
GA
Zip
30340-
Cell
(404) 671-7956
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Rodriguez
First
Jose erick
DOB
08/11/1985
Address
N/A
Telephone
N/A
COB
Guatemala
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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Jasmine Rodriguez 12/03/2009 Parents GA/USA
Juan Pedro 02/06/2008 Mother w/Stepfather GA/USA
NOTES

Media Authoritation

DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
Jacqueline-Entrevista