JIM-DOM-77

Code
JIM-DOM-77
Mercy ID
V-02654-01
Encounter Date
11/21/2007
Last
Jimenez
First
Dominga
DOB
11/08/1977
County
Fulton
Street
2081 Hollywood Road # E-3
City
Atlanta
State
GA
Zip
30318-
Cell
(404) 573-2365
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Adult, no formal education

Spouse Information

Last
Valle
First
Apolinar
DOB
N/A
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
YES
Fulton
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
YES
Consentimiento De Participar
No

Petitioner

TPO
YES
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
YES
As A Child
YES
Relative
No
Stranger
No
As An Adult
YES
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Alex Jimenez 07/12/2000 Mother w/Stepfather GA/USA
Imanol Aguirre 04/25/2006 Mother w/Stepfather GA/USA
Jason Aguirre 07/03/2001 Mother w/Stepfather GA/USA
Michelle Jimenez 07/13/2004 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Aguirre
First
Alejandro
DOB
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
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
DFCS