ARR-PAT-64

Code
ARR-PAT-64
Mercy ID
V-00002-01
Encounter Date
01/05/2000
Last
Arrieta
First
Patricia
DOB
06/30/1964
County
Dekalb
Street
4717 Roswell Rd. Apt E-2
City
Atlanta
State
GA
Zip
30342-
Home
(404) 421-0236
Cell
(678) 365-7717
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Ramirez
First
Jorge
DOB
05/20/1964
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
YES
Consentimiento De Participar
YES

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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Angel Ramirez N/A Mother GA/USA
Armando Ramirez 03/22/1994 Mother GA/USA
Benjamin Ortiz 04/09/1986 Mother GA/USA
Nallely Ortiz 06/01/1984 Mother GA/USA
Neiva Ortiz 06/15/1987 Mother GA/USA
Ruben Ortiz 05/10/1988 Mother GA/USA
NOTES
Signed consent form and promesa before the fire

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
Old Client