Professional Documents
Culture Documents
ENTREVISTA
Fecha de estudio___________________
1. DATOS GENERALES
A) PERSONALES
NOMBRE.-________________________________________________________
APODO.-
(SI)
(NO)
NACIONALIDAD.-_________________________________
CASA HABITACIN
PROPIA ( )
RENTADA ( )
PRESTADA ( )
OTRA ( )
Especificar caracteristicas.________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
NUMERO DE HABITANTES.- ____________ RELACIN DE PARENTESCO.________________________________________________________________________________________
________________________________________________________________________________________
PROFESA ALGUNA RELIGIN.(SI)
(NO)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
PRIMARIA ( )
SECUNDARIA ( )
PREPARATORIA ( )
GRADO.-__________
NOMBRE DE LA INSTITUCIN.-_____________________________________________________________
RAZN POR LA QUE LLEGO HASTA ESE GRADO.- _______________________________________________
_______________________________________________________________________________________
ECONMICAS
FAMILIARES
CAMBIO DE RESIDENCIA
EXPULSIN
VOLUNTAD PROPIA
OTRA
(
(
(
(
(
(
)
)
)
)
)
)
ESPECIFICAR RAZN.________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
RENDIMIENTO ACADMICO.________________________________________________________________________________________
________________________________________________________________________________________
C) HISTORIA LABORAL
EMPLEO PREVIO A SU DETENCIN.-___________________________________________________________
TIEMPO.-______________________SALARIO.-__________________________________________________
HORARIO.______________________
EMPLEO ANTERIOR.-_______________________________________________________________________
TIEMPO.-______________________SALARIO.-__________________________________________________
HORARIO.______________________
MOTIVO DE SEPARACIN LABORAL.________________________________________________________________________________________
________________________________________________________________________________________
UTILIDAD DEL SUELDO.________________________________________________________________________________________
________________________________________________________________________________________
D) HISTORIA FAMILIAR
NOMBRE DEL PADRE.-______________________________________________________________________
OCUPACION.-_____________________________________________________________________________
DOMICILIO.-______________________________________________________________________________
ADICCIONES.(SI)
(NO)
ESPECIFICAR CUALES Y FRECUENCIA DE USO.________________________________________________________________________________________
________________________________________________________________________________________
PADECE ALGUNA ENFERMEDAD (SI)
(NO)
CUAL.-_________________________________
TIPO DE RELACIN FAMILIAR.-_______________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
ANTECEDENTES ANTISOCIALES Y/O PENALES
(SI)
(NO)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
NOMBRE DE LA MADRE.-___________________________________________________________________
OCUPACION.-_____________________________________________________________________________
DOMICILIO.-______________________________________________________________________________
ADICCIONES.(SI)
(NO)
ESPECIFICAR CUALES Y FRECUENCIA DE USO.________________________________________________________________________________________
________________________________________________________________________________________
PADECE ALGUNA ENFERMEDAD (SI)
(NO)
CUAL.-_________________________________
(SI)
(NO)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
ENFERMEDADES.-
(SI)
(NO)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
TIPO DE RELACIN FAMILIAR.________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
2. SITUACIN LEGAL
FECHA DE INGRESO.- _______________________________________________________________________
INFRACCIN.-_____________________________________________________________________________
FUERO.-_________________________________________________________________________________
SITUACIN JURDICA.-______________________________________________________________
SETENCIA.-_______________________________________________________________________
TIEMPO TRANSCURRIDO DEL INGRESO A LA FECHA._______________________________________________________________________________
AUTOR.NICO ( )
CMPLICE
( )
PRINCIPAL
ENCUBRIDOR
TIPO DE INFRACCIN.ORGANIZADA ( )
DESORGANIZADO ( ) OCASIONAL ( )
ENCUBRIDOR ( )
ESPECIFICAR.________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
INFLUENCIA CRIMINGENA.CONTAMINANTE
( )
CONTAMINABLE
REINCIDENTE (
HABITUAL (
ACEPTA LA INFRACCIN.SI
( )
NO
( )
PARCIAL
JUSTIFICANTE
POR QU?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
ESTADO EMOCIONAL Y/O FSICO EN EL MOMENTO DE LA INFRACCIN.________________________________________________________________________________
________________________________________________________________________________
ACTITUD POS DELICTIVA.FUGA
OCULTAMIENTO
NEGACIN
CINISMO
INDIFERENCIA
(
(
(
(
(
)
)
)
)
)
ANSIEDAD
ARREPENTIMIENTO
CONFESIN
ENTREGA ESPONTANEA
SATISFACCIN
MODUS OPERANDI
( )
( )
( )
( )
(
)
CRIMINOGNESIS:
Edad de inicio:_____________
Adiccin a:
Recurrencia:
Temporalidad:
Cantidad: Efecto:
Alcohol
y/o
Tabaco
Experimental
Ocasional
Social
Habitual
Experimental
Recurrente
Consuetudinaria
Mnima
Media
Alta
Estimulante
Depresor
Marihuana
Experimental
Ocasional
Social
Habitual
Experimental
Recurrente
Consuetudinaria
Mnima
Media
Alta
Estimulante
Depresor
Herona
Experimental
Ocasional
Social
Habitual
Experimental
Recurrente
Consuetudinaria
Mnima
Media
Alta
Estimulante
Depresor
Cocana
Experimental
Ocasional
Social
Habitual
Experimental
Recurrente
Consuetudinaria
Mnima
Media
Alta
Estimulante
Depresor
Experimental
Inhalantes
Ocasional
(especificar) Social
Habitual
Experimental
Recurrente
Consuetudinaria
Mnima
Media
Alta
Estimulante
Depresor
Experimental
Otros
Ocasional
(especificar) Social
Habitual
Experimental
Recurrente
Consuetudinaria
Mnima
Media
Alta
Estimulante
Depresor
EXPLORACIN CLNICA:
APARIENCIA FSICA Y ACTITUD.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
____________________________________________________________________________
VESTIMENTA HABITUAL.
________________________________________________________________________________
___________________________________________________________________________
DESCRIPCIN.
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
SIGNIFICADO.
________________________________________________________________________________
___________________________________________________________________________
TATUAJES
NO ( )
SI ( )
CUNTOS________
DESCRIPCIN:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
SIGNIFICADO DEL MISMO:
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
LOCALIZACIN:
________________________________________________________________________________
___________________________________________________________________________
ENFERMEDADES:
(SI)
(NO)
INFECCIONES RESPIRATORIAS
GASTROINTESTINALES
HORMONALES
TRANSMISIN SEXUAL
POR HONGOS
HEMATOLGICAS
NUTRICIONALES
ALERGIAS
NEUROPSIQUIATRAS
ESPECIFICAR:_____________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
COMPORTAMIENTO INTERINSTITUCIONAL:
REA EDUCATIVA AL INTERIOR DEL ESTABLECIMIENTO DE REHABILITACIN.
ACTIVIDADES ESCOLARES:
SI
NO
REA LABORAL:
SI
NO
ESPECIFICAR (ACTIVIDAD, HORARIOS, SALARIO)
________________________________________________________________________________
________________________________________________________________________________
______________________________________________________________________________
ACTIVIDADES CULTURALES:
SI
NO
ESPECIFICAR:
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
ACTIVIDADES DEPORTIVAS:
SI
NO
ESPECIFICAR:
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
NDICES CRIMINOLGICOS.
ANTECEDENTES ANTISOCIALES:
SI
NO
ESPECIFICAR CONDUCTAS:
________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________
ANTECEDENTES POLICIACOS:
SI
NO
ESPECIFICAR MOTIVO:
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
ANTECEDENTES PENALES:
SI
NO
ESPECIFICAR MOTIVO:
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
ANTECEDENTES FAMILIARES.
NOMBRE Y PARENTESCO DEL FAMILIAR E INGRESO A:
________________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________
CERESO
( )
SEGURIDAD PUBLICA
( )
TRIBUNAL PARA MENORES INFRACTORES ( )
MOTIVO:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
VICTIMOLOGA:
1. DATOS SOBRE LA VICTIMA.
PERSONA MORAL ( )
PERSONA FSICA ( )
ESPECIFICAR:
________________________________________________________________________________
___________________________________________________________________________
CONSECUENCIAS DEL ILCITO EN RELACIN CON LA VICTIMA:
________________________________________________________________________________
___________________________________________________________________________
CRIMINO-DIAGNOSTICO.
CARACTERSTICAS DE PERSONALIDAD RELACIONADAS CON EL DELITO (QUE SE CONSIDERAN
RELEVANTES PARA INFLUIR EN SU PROCESO DE REINCORPORACIN SOCIAL)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
CRIMINOGNESIS (FACTORES BIOLGICOS, PSICOLGICOS Y SOCIALES QUE FAVORECEN LA
COMISIN DEL DELITO)
Cmo considera el acto que usted realizo? (debido, indebido, se arrepiente, no saba que era
delito)
________________________________________________________________________________
___________________________________________________________________________
Cometi delitos con anterioridad? (De qu tipo, enumrelos, se arrepiente, etc)
________________________________________________________________________________
________________________________________________________________________________
___________________________________________________________________________
FACTORES PSICOCRIMINOGENOS:
Endgenos:__________________________________________________________________
Exgenos o preparantes:________________________________________________________
Desencadenantes: ____________________________________________________________
CRIMINODINAMIA:
CAUSA CRIMINGENA:__________________________________________________________
MVIL CRIMINGENO:_________________________________________________________
FACTOR CRIMINGENO:________________________________________________________
ALEGRE: ( )
INDIFERENTE: ( )
NO ( ) (POR QUE)
_________________________________________________________________________
_________________________________________________________________________
DESCRIPCIN DE LOS HECHOS:
Antes de la comisin del delito:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Durante la comisin del delito:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Despus de la comisin de los hechos:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
DIAGNOSTICO DE PERSONALIDAD CRIMINAL
ACTUALMENTE SU:
EGOCENTRISMO ES:
LABILIDAD AFECTIVA:
AGRESIVIDAD:
INDIFERENCIA AFECTIVA:
ESPECIFICAR:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
PERSONALIDAD
TEMPERAMENTO
RESERVADO
ANTISOCIAL
MEDITATIVO
COMPORTAMIENTO
DUBITATIVO
DELICTIVO
DEFENSIVO
SOLICITO
ABIERTO
AMABLE
ADAPTABLE
FCIL
RELACIN
CARACTEROLOGA
NERVIOSO
COLRICO
APASIONADO
AMORFO
SANGUNEO
MELANCLICO
FLEMTICO
APTICO
EDO. DE
CONCIENCIA
TIPO DE DAO
CAUSADO
CONDUCTA
REALIZADA
INCONSCIENTE
CONSCIENTE
PERSONA
PATRIMONIO
MATERIALES
SOCIAL
DOLOSA
ACCIN /OMISIN IMPRUDENCIAL O
CULPOSA
INTENCIONALIDAD
CAPACIDAD CRIMINAL:
ESTADO PELIGROSO:
_________________________________________________________________________
_________________________________________________________________________
UMBRAL CRIMINAL:
_________________________________________________________________________
_________________________________________________________________________
PASO AL ACTO:
_________________________________________________________________________
_________________________________________________________________________
ADAPTABILIDAD SOCIAL EXTERNA:
_________________________________________________________________________
_________________________________________________________________________
MNIMA MEDIA ( )
MEDIA ALTA ( )
ALTA ( )
MEDIA ( )
ESPECIFICAR:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
PRONOSTICO DE REINCIDENCIA:
ALTO ( )
MEDIO ( )
BAJO ( )
ESPECIFICAR:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
INCOHERENTE EN SU NARRATIVA ( )
ENTREVISTADOR: _________________________________________________________________
FECHA: ____________________________