ROD-IRI-75

Code
ROD-IRI-75
Mercy ID
V-03520-01
Encounter Date
02/01/2011
Last
Rodriguez
First
Iris
DOB
01/25/1975
County
Dekalb
Street
3397 Cumberland Dr. Apt. D
City
Chamblee
State
GA
Zip
30341-
Cell
(404) 454-2571
Other
(404) 748-5353
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Mendez
First
Antonio
DOB
07/16/1984
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
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
YES
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
Andrea Villanueva 11/29/2001 Mother GA/USA
Jessi Villanueva 04/06/1997 Mother GA/USA
Luna Villanueva 04/04/2005 Mother GA/USA

Former Spouse 1 Information

Last
Villanueva
First
Jesus
DOB
10/15/1969
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