INE-JES-78

Code
INE-JES-78
Mercy ID
V-00805-01
Encounter Date
01/16/2002
Last
Inestrosa
First
Jessica
DOB
02/17/1978
County
Fulton
Street
3107 Delmar Lane
City
Atlanta
State
GA
Zip
30311-
Home
(404) 696-8766
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Guillen
First
Antonio
DOB
N/A
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
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
Ruth Elizabeth Inestrosa 08/01/1999 Mother GA/USA

Former Spouse 1 Information

Last
Zamora
First
Dennis
DOB
N/A
Telephone
N/A
COB
N/A
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
K. Aleman
Referred By