Anamnesis Historial Criminológico – Adulto

 [pic 1][pic 2]

Anamnesis

Historial Criminológico – Adulto

Entrevistador: ______________________ Fecha: __________________

I.- Datos del Sujeto:

     Apellidos y Nombre: _______________________________________________

     Fecha y lugar de nacimiento: ________________________________________

     Instrucción: __________________ Ocupación: __________________________

     Estado Civil: __________________ Religión: ____________________________

     Nombre del Padre: _________________________________________________

     Telef: ___________________________________________________________

     Nombre de la Madre: _______________________________________________

     Telef: ___________________________________________________________

     Hermanos: _______________________________________________________

     Edades: _________________________________________________________

    Centro de Estudios: _________________________________________________

     Grado: __________________________________________________________

     Lugar de Habitación: _______________________________________________

     Procedencia: _____________________________________________________

     Teléfonos: _______________________________________________________

     Email: ___________________________________________________________

II.- Problema Actual:

     Motivo de Conducta – Problema Actual:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

     Factores desencadenantes del Problema Actual:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

     Auto-descripción de la Personalidad:

• ¿Cómo describiría su personalidad?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

• ¿Cuál es la Filosofía de Vida?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

III.- Historia Personal y Social:

• Desarrollo Psicomotor:

Lenguaje: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

• Edad en la que empezó a caminar:

______________________________________________________________________________________________________________________________________

• Crianza de los padres:

1. Solo Padre: ____________________________________________________
2. Solo Madre: ____________________________________________________
3. Ambos: _______________________________________________________
4. Otro(s) Pariente(s): _____________________________________________

• Carácter y Comportamiento en los primeros años:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

• Relación Social (Niñez):

Con los Padres:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Con los Hermanos:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

...