JIM-CEC-78

Code
JIM-CEC-78
Mercy ID
V-01911-01
Encounter Date
04/02/2010
Last
Jimenez
First
Cecilia
DOB
11/22/1978
County
Dekalb
Street
999 no la sabe
City
Atlanta
State
GA
Zip
30329-
Cell
(678) 851-5308
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
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
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
Alma D. Flores 04/21/2000 Mother GA/USA
Vicente Jimenez 05/06/2004 Mother GA/USA

Former Spouse 1 Information

Last
Flores
First
Vicente
DOB
07/21/1980
Telephone
N/A
COB
Mexico
Home Owner
YES
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Juana