ROD-MAR-75

Code
ROD-MAR-75
Mercy ID
V-00440-01
Encounter Date
03/07/2001
Last
Rodriguez
First
Maribel
DOB
05/28/1975
County
Gwinnett
Street
P.O. Box 171
City
Decatur
State
GA
Zip
30331-
Home
(770) 322-1153
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Shelter
Education Level
some high school

Spouse Information

Last
Simon
First
Jose
DOB
07/17/1970
Address
6680 Peachtree Industrial R-2 Decatur, GA 30031
Telephone
(770) 441-3177
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
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
Marilan Simon 06/21/1998 Mother GA/USA
Virginia Rodriguez 11/30/1999 Mother 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
D. Gomez
Referred By
7764 maria eugenia