RAY-ROS-83

Code
RAY-ROS-83
Mercy ID
V-02999-01
Encounter Date
02/07/2009
Last
Raymundo
First
Rosa
DOB
10/23/1983
County
Dekalb
Street
2696 Chamblee Tucker Road
City
Chamblee
State
GA
Zip
30341-
Cell
(678) 476-0873
Other
(770) 413-5557
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Shelter
Education Level
Grade school

Spouse Information

Last
Morales
First
Benjamin
DOB
11/16/1981
Address
N/A
Telephone
N/A
COB
Guatemala
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
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
Jacqueline-Kim-WRC