ROM-ROS-77

Code
ROM-ROS-77
Mercy ID
V-03489-01
Encounter Date
12/22/2010
Last
Romero
First
Rosa
DOB
11/11/1977
County
Gwinnett
Street
1088 Blazing Ridge Road
City
Lawrenceville
State
GA
Zip
30046-
Cell
(770) 882-9494
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
N/A
First
N/A
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
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
Juan C. Romero 11/15/2003 Mother GA/USA

Former Spouse 1 Information

Last
Ortiz
First
Herles
DOB
09/09/1962
Telephone
N/A
COB
Perú
Home Owner
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
linea-Maria Fernanda