MAN-ROS-60

Code
MAN-ROS-60
Mercy ID
V-00312-01
Encounter Date
10/30/2001
Last
Mancha
First
Rosa
DOB
03/04/1960
County
Gwinnett
Street
2561 Valley Dr.
City
Norcross
State
GA
Zip
30071-
Home
(770) 242-8487
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Avalos
First
Meliton
DOB
04/01/1958
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
YES
Consentimiento De Participar
YES

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
YES
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
Erik Avalos 07/24/1982 Parents GA/USA
Gabriel Avalos 11/25/1990 Parents GA/USA
Luis Avalos 08/12/1978 Parents GA/USA
Mauricio Avalos 08/12/1988 Parents GA/USA
Rocio Avalos 11/12/1981 Parents GA/USA
Rosa Avalos 12/20/1984 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
Walk-in