ROD-JOS-89

Code
ROD-JOS-89
Mercy ID
V-03433-02
Encounter Date
09/28/2010
Last
Rodriguez
First
Jose
DOB
01/02/1989
County
Dekalb
Street
3630 Shallowford Rd. C-6
City
Doraville
State
GA
Zip
30340-
Cell
(404) 573-9782
Other
(404) 671-7956
Family Status
Single adult
COB
Guatemala
Gender
Male
Housing
Doubling Up
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
YES
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
YES
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
Jasmin Amparo Rodriguez 12/03/2009 Mother GA/USA
Juan Pedra 02/03/2008 Mother GA/USA

Former Spouse 1 Information

Last
Pedro
First
Susana
DOB
08/11/1985
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. Manzo
Data Entry
J. Manzo
Referred By
Jackie's cell/Dekalb court