DOM-MAR-62

Code
DOM-MAR-62
Mercy ID
V-01961-01
Encounter Date
07/08/2005
Last
Dominguez
First
Martha
DOB
02/24/1962
County
Cobb
Street
1080 Pinemeadow Dr.
City
Morrow
State
GA
Zip
30260-
Home
(404) 608-8417
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Alverto
First
Alejandro
DOB
07/10/1959
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
Alejandro Alverto 12/09/1981 N/A GA/USA
Antoni Camacho 02/06/2001 N/A GA/USA
Antonio Alverto 10/11/1988 N/A GA/USA
Maria Alverto 02/08/1990 N/A GA/USA
Vicente Alverto 05/09/1985 N/A 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