DR 160031200__XX_RedactedLONG BEACH POLICE DEPARTMENT e'
DOMESTIC VIOLENCE
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DID#1 OFF#1 `DID#2 OFF#2
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RELATIONSHIP BETWEEN VICTIMAND SUSPECT
mark all that apply)
SPOUSE COHABITANTS DATING OR ENGAGED SAMESEX PARENT OF CHILD FROM
FORMERSPOUSE FORMERCOHABITANTS FORMERDATING EMANCIPATEDMINOR RELATIONSHIP
LENGTH OF RELATIONSHIP O YEAR(s)_'"MONTH(s)IFAPPLICABLE,DATE REALTIONSHIP ENDED
HISTORY
PRIOR HISTORY OF DOMESTIC VIOLENCE YES ,NO NUMBER OF PRIOR INCIDENTS —'
PRIOR HISTORY OF VIOLENCE DOCUMENTED YES NO AGENCY CASE# 6 06 Z y b 2.police or medical reports)
PRIOR POLICE REPORT FILED JYES NO AGENCY LgPD CASE#_oa Z yb2
RESTRAINING ORDERS
RESTRAINING ORDER ISSUED YES NO CURRENT EXPIRED ATTACHED
TYPE OF ORDER EMEI GENCY(EPO) TEMPORARY(TRO) PERMANENT(DVRO) PROTECTIVE ORDER IN CRIMINAL PROCEEDING
ISSUING COURT ORDER OR DOCKET# SERVED YES NO
CHILDREN
CHILDREN PRESENT DURING DOMESTIC VIOLENCE YES 10 DEPT OF CHILDREN/FAMILY SERVICES NOTIFIED ' YES 'NO
E SIX RACE DOBNaN
PHOTOGRAPHS
PHOTOS REQUESTED ES NO
IF"NO"CHECK ONE OF THE FOLLOWING LAB UNAVAILABLE NO FIELD CAMERAAVAILABLE NO VISIBL H{IJRIES
OTHER W
MEDICAL RELEASE
TO ALL HEALTH CARE PROVIDERS: Having been advised of my right to refuse, I hereby consent to the release of my mediqi records to law enforcement,theDisfictAttomey's Office, and the City Prosecutor's O ce.
Signature Date 4 ~llO ^ c.(J!
PD2310.035(A)(REV.'10/14/
r_
LONG BEACH POLICE DEPARTMENT°;
CHOKING (STRANGULATION) CASES`'''
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HOW WAS THE VICTIM STRANGLED(check if applicable):
ONE HAND TWO HANDS FOREARM(s) VICTIM SHAKEN OBJECT(s)
HOW LONG WAS VICTIM STRANGLED HOW MANY TIMES WASVICTIM STRANGLED
DESCRIBE HOW VICTIM WAS STRANGLED(have victim demonstrate):
WHAT DID THE SUSPECT SAY WHILE STRANGLING THEVICTIM:
N /P
DESCRIBE HOW MUCH PRESSURE WAS USED:
D lP rn
C
ti:;1
DID THE VICTIM ATTEMPT TO PROTECTHERSELF/HIMSELF(describe): W
JC f E
VICTIM INJURIES(check if applicable):
DIFFICULTY BREATHING LOST CONSCIOUSNESS CAPILLARY RUPTURE(red spots in white portion of eyes)
HOARSE OR RASPY VOICE HOW LONG BLOODSHOT/RED EYES(hemorrhage)
PAIN TO THROAT URINATED DURING STRANGULATION LIGATURE MARKS(rope bums)
TROUBLE SWALLOWING DEFECATED DURING STRANGULATION VISIBLE MARKS FROM HANDS/FINGERS
DIZZY OR FAINT VOMITED
NAUSEA COUGHING UP BLOOD f
ADDITIONALREMARKS
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PD2310.035(B)(REV 10/14/98)