DOM-CON-75

Code
DOM-CON-75
Mercy ID
V-00974-01
Encounter Date
07/23/2002
Last
Dominguez
First
Consuelo
DOB
12/17/1975
County
Gwinnett
Street
228 Griffin St.
City
Lawrenceville
State
GA
Zip
30045-
Home
(770) 682-3130
Family Status
Single parent w/children
COB
Dominican Rep
Gender
Female
Housing
Other
Education Level
Some College

Spouse Information

Last
Bashir
First
Tahir
DOB
N/A
Address
N/A
Telephone
N/A
COB
Pakistan
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Kaitlyn Dominguez 08/21/2002 Mother GA/USA
Kiara Bashir 02/05/1999 Mother GA/USA
Kimberly Bashir 09/06/1995 Mother GA/USA
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
x7764 Ma. Eugenia