ROL-RAQ-01

Code
ROL-RAQ-01
Mercy ID
V-02519-01
Encounter Date
06/20/2007
Last
Roldan
First
Raquel
DOB
12/17/1961
County
Gwinnett
Street
1415 Gabriel Dr.
City
Lawrenceville
State
GA
Zip
30043-
Home
(770) 338-2119
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless

Spouse Information

Last
Roldan
First
Ramon
DOB
12/21/1957
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
YES
Consentimiento De Participar
YES

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
Joseline Roldan 09/07/1992 Parents GA/USA
Josue Roldan 06/03/1996 Parents GA/USA
Natalia Roldan 01/17/2003 Parents GA/USA
Ramon Roldan 05/29/1994 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
J. Manzo
Referred By
walk in