DOM-ELV-74

Code
DOM-ELV-74
Mercy ID
V-01415-01
Encounter Date
11/10/2003
Last
Dominguez
First
Elvira
DOB
01/12/1974
County
Fulton
Street
3968 Lasaye Way
City
Atlanta
State
GA
Zip
30331-3806
Home
(404) 696-6585
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Ramos
First
Isidro
DOB
05/15/1972
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
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Isidro Ramos 03/03/2000 Mother GA/USA
Lizbeth Ramos 05/07/1994 Mother GA/USA
Luz edelia Ramos 05/22/1993 Mother GA/USA
Melissa Ramos 07/21/1996 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
K. Aleman
Referred By