ROM-MAR-84

Code
ROM-MAR-84
Mercy ID
V-03504-01
Encounter Date
01/05/2011
Last
Romero
First
Maria
DOB
07/16/1984
County
Other
Street
321 Aereopuerto Blvd.
City
Freedom
State
CA
Zip
95019-
Home
(831) 768-7831
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Ambrosio
First
Felix
DOB
06/06/1980
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
Itzel Romero 09/03/2002 Mother w/Stepfather GA/USA
Lariana Romero 06/05/2007 Mother w/Stepfather GA/USA
Loret Romero 04/25/2004 Mother w/Stepfather GA/USA
Pablo Romero 06/13/1999 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Romero
First
Artemio
DOB
N/A
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
linea-Juana/Internet