VAL-IRM-67

Code
VAL-IRM-67
Mercy ID
V-00203-01
Encounter Date
05/10/2000
Last
Valencia
First
Irma
DOB
12/23/1967
County
Dekalb
Street
3516 Buford Hwy #8
City
Atlanta
State
GA
Zip
30329-
Home
(404) 982-0966
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Espinoza
First
Carlos
DOB
N/A
Address
N/A
Telephone
(770) 458-8565
COB
Cuba
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
YES
Consentimiento De Participar
YES

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
Alexis Valencia 03/05/2001 Parents GA/USA
Jonathan Roura 12/16/1999 Mother GA/USA
Rodrigo Valencia 09/22/1995 Mother GA/USA

Former Spouse 1 Information

Last
Garcia
First
Rogelio
DOB
01/25/1962
Telephone
(770) 458-8565
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
Y. Garcia
Referred By
x7764 Karina