FAR-REB-81

Code
FAR-REB-81
Mercy ID
V-03509-01
Encounter Date
01/21/2011
Last
Farfan
First
Rebeca
DOB
03/16/1981
County
Fulton
Street
1184 Lowe Lane
City
Roswell
State
GA
Zip
30076-
Cell
(678) 964-0227
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
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
Amanda Castro 05/31/1999 Mother GA/USA
Jennifer Castro 08/31/2005 Mother GA/USA
Jose D. Castro 02/20/2007 Mother GA/USA
Leslie Castro 05/20/2002 Mother GA/USA

Former Spouse 1 Information

Last
Castro
First
Jose
DOB
06/23/1974
Telephone
N/A
COB
Mexico
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-Juana