JIM-SIL-65

Code
JIM-SIL-65
Mercy ID
V-00296-02
Encounter Date
09/26/2000
Last
Jimenez
First
Silverio
DOB
03/05/1965
County
Fulton
Street
5801 Kingsport Dr. Apt. 202
City
Roswell
State
GA
Zip
30342-
Home
(404) 459-7184
Family Status
Single adult
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
College Degree

Spouse Information

Last
Rabadan
First
Guadalupe
DOB
12/07/1963
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
javier N/A Mother GA/USA
jose luis N/A Mother GA/USA
NOTES

Media Authoritation

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