ROM-SIL-79

Code
ROM-SIL-79
Mercy ID
V-02039-01
Encounter Date
09/23/2005
Last
Roman
First
Silvia
DOB
02/17/1979
County
Dekalb
Street
2856 Pinegrove Ter
City
Atlanta
State
GA
Zip
30319-
Home
(404) 438-6865
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Chavez
First
Gilberto
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
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
Christoper Chavez 05/23/2005 Parents GA/USA
Juan Manuel Figueroa 09/07/1996 Grandparents mexico
Victor Alberto Figueroa 10/22/1998 Parents GA/USA
Viliyuvil Figueroa 12/21/2000 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
R. Gonzalez
Referred By