MOL-JAK-78

Code
MOL-JAK-78
Mercy ID
V-01799-01
Encounter Date
01/10/2005
Last
Molina
First
Jakelin
DOB
11/01/1978
County
Gwinnett
Street
6077 South Norcross
City
Norcross
State
GA
Zip
30093-
Home
(678) 789-4921
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Martinez
First
Denis
DOB
N/A
Address
N/A
Telephone
N/A
COB
Nicaragua
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Angi Martinez 10/05/2003 Mother GA/USA
Jonathan Martinez 10/05/2003 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
x1375 Damaryz