IDI-CUL-70

Code
IDI-CUL-70
Mercy ID
V-02302-01
Encounter Date
08/09/2006
Last
Idizalde
First
Dulce
DOB
10/03/1970
County
Fulton
Street
3385 Atkins Rd.
City
Atlanta
State
GA
Zip
30331-
Home
(770) 317-7578
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Transitional
Education Level
Adult, no formal education

Spouse Information

Last
Simmons
First
George
DOB
10/04/1966
Address
N/A
Telephone
(770) 317-7578
COB
USA
Home Owner
YES
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
George Simmons 12/09/2003 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
J. Manzo
Referred By
walkin