DOM-MAR-58

Code
DOM-MAR-58
Mercy ID
V-03228-01
Encounter Date
01/25/2010
Last
Dominguez
First
Maria e
DOB
09/02/1958
County
Clayton
Street
6500 Bocagrande Blvd.
City
Forest park
State
GA
Zip
30297-
Home
(678) 519-3491
Cell
(404) 886-4808
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Adult, no formal education

Spouse Information

Last
Calvillo
First
Everardo
DOB
08/04/1955
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
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
No
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
Alfredo Calvillo 08/13/1991 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
Radio el Patron