RUB-TAN-75

Code
RUB-TAN-75
Mercy ID
V-03440-01
Encounter Date
10/04/2010
Last
Rubio
First
Tania
DOB
05/18/1975
County
Jasper
Street
9999 NO LA QUISO DAR
City
Newborn
State
GA
Zip
30143-
Cell
(678) 557-1134
Family Status
Two parent family w/children
COB
USA
Gender
Female
Housing
Single Family
Education Level
College Degree

Spouse Information

Last
Rubio
First
Whitnan
DOB
N/A
Address
N/A
Telephone
N/A
COB
El Salvador
Home Owner
YES
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
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
Allison Rubio 10/22/2002 Mother GA/USA
Antony Rubio 03/06/2004 Mother GA/USA
Ashey Mendez 10/08/2000 Mother GA/USA
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
Jacqueline