JIM-CAR-61

Code
JIM-CAR-61
Mercy ID
V-01599-01
Encounter Date
05/14/2004
Last
Jimenez
First
Carmen g
DOB
08/24/1961
County
Fulton
Street
3408 Orchard St.
City
Hapeville
State
GA
Zip
30354-
Home
(404) 209-7146
Family Status
Two parent family w/children
COB
Dominican Rep
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Acosta
First
Francisco
DOB
10/10/1960
Address
N/A
Telephone
N/A
COB
Dominican Rep
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
YES
Consentimiento De Participar
YES

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
Katty Acosta 10/31/1987 Parents GA/USA
Kevin Acosta 10/11/1993 Parents 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
Rafael Miranda