DOM-SAN-68

Code
DOM-SAN-68
Mercy ID
V-02286-01
Encounter Date
07/12/2006
Last
Dominguez
First
Sandra
DOB
02/06/1968
County
Dekalb
Street
3146 Chamblee Dunwoody Rd.
City
Chamblee
State
GA
Zip
30341-
Home
(910) 233-5826
Cell
(910) 234-9385
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Transitional
Education Level
Grade school

Spouse Information

Last
Mustillo
First
Simon
DOB
02/17/1965
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Diana Bustillo 02/08/1994 Aunt Mexico
Diego Bustillo 08/25/1995 Aunt Mexico
Guadalupe Bustillo 12/11/1990 Aunt Mexico
Jose del Carmen Bustillo 07/16/1988 Aunt Mexico
Salvador Bustillo 01/23/1991 Aunt Mexico
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
walk in