RIV-ADR-78

Code
RIV-ADR-78
Mercy ID
V-02007-01
Encounter Date
07/29/2005
Last
Rivera
First
Adriana
DOB
08/12/1978
County
Cobb
Street
Ridge Run SE #o
City
Marietta
State
GA
Zip
30067-
Home
(678) 334-8498
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
High school graduate

Spouse Information

Last
Ugalde
First
Francisco
DOB
03/09/1975
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
Francisco Ugalde 08/16/2000 Parents GA/USA
Ximena Ugalde 09/01/2003 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
K. Aleman
Referred By