ESP-ALM-76

Code
ESP-ALM-76
Mercy ID
V-00121-01
Encounter Date
02/29/2000
Last
Espinoza
First
Alma
DOB
02/28/1976
County
Paulding
Street
2390 Fairburn Rd. Lot 49
City
Douglasville
State
GA
Zip
30135-
Home
(678) 838-9394
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Octavio
First
Espinoza
DOB
07/18/1972
Address
N/A
Telephone
(678) 833-9394
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
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Amy Espinoza N/A Parents GA/USA
Andrea Espinoza 02/28/1996 Father w/Stepmother GA/USA
Jovanna Hernandez N/A Mother GA/USA
Stephanie Espinoza 05/17/2000 Parents GA/USA
NOTES
Signed consent form and promesa before the fire

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
Y. Garcia
Referred By