CAM-IRL-79

Code
CAM-IRL-79
Mercy ID
V-01980-01
Encounter Date
08/11/2005
Last
Campos vazquez
First
Irlanda suzuki
DOB
11/06/1979
County
Dekalb
Street
homeless
City
Homeless
State
GA
Zip
00000-0000
Home
(000) 000-0000
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Street
Education Level
some high school

Spouse Information

Last
Ramblas
First
Julio
DOB
12/05/1978
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
Brian N. Ramblas Campos 12/16/1999 Mother GA/USA
Kimberly N. Ramblas Campos 04/20/2003 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
K. Aleman
Referred By
CMS_Felipe