DOM-EVE-78

Code
DOM-EVE-78
Mercy ID
V-03449-02
Encounter Date
10/26/2010
Last
Dominguez
First
Everardo
DOB
04/29/1978
County
Gwinnett
Street
3726 Jackson Shoals Lot 90-A
City
Lawrenceville
State
GA
Zip
30044-
Home
(770) 279-5023
Cell
(770) 616-6437
Family Status
Adult couple-no children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
High school graduate

Spouse Information

Last
Dominguez
First
Evin
DOB
N/A
Address
N/A
Telephone
N/A
COB
USA
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
No
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
J. Manzo
Referred By
linea- Psy/Sara Lopez