ROD-MAR-85

Code
ROD-MAR-85
Mercy ID
V-01791-01
Encounter Date
12/23/2004
Last
Rodriguez
First
Maria antonia
DOB
06/13/1985
County
Gwinnett
Street
209 Club Pkwy
City
Norcross
State
GA
Zip
30093-
Home
(770) 875-8671
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Other
Education Level
Other

Spouse Information

Last
Barragan
First
Fidel
DOB
N/A
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
Liczely Barragan 12/25/2000 N/A GA/USA
Saul Barragan 10/21/2003 N/A GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
Clinica/ Damaryz