RAM-SUS-84

Code
RAM-SUS-84
Mercy ID
V-02996-01
Encounter Date
02/03/2009
Last
Ramirez
First
Susana
DOB
06/09/1984
County
Gwinnett
Street
202 Club Parkway
City
Norcross
State
GA
Zip
30093-
Cell
(708) 983-8524
Other
(708) 526-1599
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Aguirre
First
Ramon
DOB
11/30/1978
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
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
kassandra Aguirre 03/03/2004 Parents GA/USA
Nancy Aguirre 10/10/2006 Parents 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
J. Manzo
Referred By
Clienta- Ma. Salazar