REY-JOS-04

Code
REY-JOS-04
Mercy ID
V-01893-02
Encounter Date
08/23/2005
Last
Reyes
First
Jose
DOB
04/05/1969
County
Gwinnett
Street
3115
City
Duluth
State
GA
Zip
30069-
Home
(101) 319-5698
Family Status
Adult coupie-no children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Zapata
First
Marisol
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
YES
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
Javier 09/05/1997 Mother GA/USA
Jose 07/14/2000 Mother GA/USA
Monica 01/29/1995 Mother GA/USA
NOTES
There is another Reyes, Jose in the data base, with the same code of REY-JOS-69. For this male I used the month of his birthdate to complete the new code.

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
R. Miranda
Data Entry
R. Gonzalez
Referred By