ANT-CIN-74

Code
ANT-CIN-74
Mercy ID
V-03111-01
Encounter Date
07/02/2009
Last
Anteliz
First
Cindy
DOB
09/12/1974
County
Douglass
Street
925 Oakcreek Apt. B
City
Douglasville
State
GA
Zip
30134-
Cell
(770) 572-3112
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Jimenez
First
Jaime
DOB
04/25/1975
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
Cindy Jimenez 12/16/1994 Parents GA/USA
Jaime Jimenez 06/16/2001 Parents GA/USA
Jeahy Jimenez 10/05/1992 Grandparents Mexico-Maternos
Renalta Jimenez 02/13/2009 Parents 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
J. Manzo
Referred By
linea-Juana