JIM-MAR-62

Code
JIM-MAR-62
Mercy ID
V-01773-01
Encounter Date
12/08/2004
Last
Jimenez
First
Maria
DOB
05/05/1962
County
Dekalb
Street
not given
City
Doraville
State
GA
Zip
00000-000
Home
(000) 000-0000
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Other

Spouse Information

Last
Jimenez
First
Francisco
DOB
09/17/1972
Address
N/A
Telephone
N/A
COB
Mexico
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
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Francisco Alberto Ramirez N/A Father w/Stepmother GA/USA
Melisa Jimenez N/A Parents GA/USA
Randy Antony Jimenez N/A Parents GA/USA
Yefery Jimenez N/A Parents GA/USA
NOTES

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