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ENTREVISTA DATOS GENERALES 1 A) PERSONALES 2 B) ANTECEDENTES ESCOLARES 2 C) HISTORIA LABORAL 2 D) HISTORIA FAMILIAR2 SITUACIÓN LEGAL 4 DINÁMICA SEGÚN EL EXPEDIENTE 4 DINÁMICA DE LA INFORMACIÓN SEGÚN EL INTERNO 4 Escribir el título del capítulo (nivel 3) 6

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ENTREVISTA

DATOS GENERALES1PERSONALES2ANTECEDENTES ESCOLARES2HISTORIA LABORAL2HISTORIA FAMILIAR2SITUACIN LEGAL4DINMICA SEGN EL EXPEDIENTE4DINMICA DE LA INFORMACIN SEGN EL INTERNO4 6

ENTREVISTAFecha de estudio___________________1. DATOS GENERALESA) PERSONALES

NOMBRE.-________________________________________________________APODO.- (SI)(NO)Apodo y razn del apodo.-______________________________________________________________________________________________________________________________________________________________EDAD.-________________NACIONALIDAD.-_________________________________LUGAR Y FECHA DE NACIEMIENTO.-________________________________________________________________________________________________________________________________________________________________________________LUGAR DE RESIDENCIA.-________________________________________________________________________________________________________________________________________________________________________________DOMICILIO EXTERIOR.-________________________________________________________________________________________________________________________________________________________________________________ESTADO CIVIL.-SOLTERO ( )CASADO ( ) UNIN LIBRE ( ) DIVORCIADO ( ) VIUDO ( )Especificar estado.- ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CASA HABITACINPROPIA ( ) RENTADA ( )PRESTADA ( )OTRA ( )Especificar caracteristicas.-________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________NUMERO DE HABITANTES.- ____________ RELACIN DE PARENTESCO.- ________________________________________________________________________________________________________________________________________________________________________________PROFESA ALGUNA RELIGIN.- (SI)(NO)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

B) ANTECEDENTES ESCOLARES (ANTES DEL INGRESO A LA INSTITUCIN)

NINGUNA ( )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.-_________________________________TIPO DE RELACIN FAMILIAR.-________________________________________________________________________________________________________________________________________________________________________________ANTECEDENTES ANTISOCIALES Y/O PENALES (SI) (NO)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________HERMANOS.-(SI) (NO)CUANTOS.-________________________NOMBRES, EDADES Y OCUPACIN.-1_______________________________________________________________________________________2_______________________________________________________________________________________3_______________________________________________________________________________________4_______________________________________________________________________________________5_______________________________________________________________________________________6_______________________________________________________________________________________

ADICCIONES.- (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.-_______________________________________________________________________________3. DINMICA DE LA INFRACCIN SEGN EL INTERNOCRIMINODINAMIA (VERSIN DEL INTERNO)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________OPININ RESPECTO A SU RESPONSABILIDAD Y A LA SANCIN.-________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AUTOR.-NICO ( ) CMPLICE ( ) PRINCIPAL( ) ENCUBRIDOR ( )

TIPO DE INFRACCIN.-ORGANIZADA ( ) DESORGANIZADO ( ) OCASIONAL ( )ENCUBRIDOR ( ) ESPECIFICAR.-________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________INFLUENCIA CRIMINGENA.-CONTAMINANTE( )CONTAMINABLE( )

CLASIFICACIN CRIMINGENA.-PRIMO DELINCUENTE ( ) HABITUAL ( )REINCIDENTE( )

ACEPTA LA INFRACCIN.-SI( )NO( )PARCIAL ()JUSTIFICANTE ( )POR QU? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ESTADO EMOCIONAL Y/O FSICO EN EL MOMENTO DE LA INFRACCIN.- ________________________________________________________________________________________________________________________________________________________________ACTITUD POS DELICTIVA.-FUGA( )ANSIEDAD ( )OCULTAMIENTO( )ARREPENTIMIENTO ( )NEGACIN( )CONFESIN ( )CINISMO( ) ENTREGA ESPONTANEA ( )INDIFERENCIA( )SATISFACCIN ( )

MODUS OPERANDI

Lugar donde se cometi el delito

Tipo de lugar

Forma de entrada o llegada

Motivo aparente

Actitud o comportamiento en el hecho

Peculiaridades cometidas

Lugares frecuentes para la comisin de la infraccin

Utensilios o herramientas

Tipo de victima

Fecha en que cometi el delito

Tipo de arma utilizada

Subtipo de arma utilizada

Tiempo estimado en la que se llev a cabo la infraccin

Caractersticas particulares del hecho

FACTOR PREDISPONENTE A LA COMISIN DEL DELITO.-

CRIMINOGNESIS:Edad de inicio:_____________Adiccin a:Recurrencia:Temporalidad:Cantidad:Efecto:

Alcohol y/o TabacoExperimental Ocasional Social Habitual Experimental Recurrente ConsuetudinariaMnima Media AltaEstimulante Depresor

MarihuanaExperimental Ocasional Social Habitual Experimental Recurrente ConsuetudinariaMnima Media AltaEstimulante Depresor

HeronaExperimental Ocasional Social Habitual Experimental Recurrente ConsuetudinariaMnima Media AltaEstimulante Depresor

CocanaExperimental Ocasional Social Habitual Experimental Recurrente ConsuetudinariaMnima Media AltaEstimulante Depresor

Inhalantes (especificar)Experimental Ocasional Social Habitual Experimental Recurrente ConsuetudinariaMnima Media AltaEstimulante Depresor

Otros (especificar)Experimental Ocasional Social Habitual Experimental Recurrente ConsuetudinariaMnima Media AltaEstimulante Depresor

ESPECIFICAR (RECURRENCIA, TEMPORALIDAD, CANTIDAD)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ANTECEDENTES FAMILIARES DEL USO DE DROGAS________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

EXPLORACIN CLNICA:APARIENCIA FSICA Y ACTITUD.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________VESTIMENTA HABITUAL.___________________________________________________________________________________________________________________________________________________________DESCRIPCIN.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________SIGNIFICADO.___________________________________________________________________________________________________________________________________________________________TATUAJESNO ( )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

ESPECIFICAR (NIVEL Y GRADO DE INICIO Y ACTUAL, RENDIMIENTO ACADMICO)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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 ( )SEXO Y EDAD: ____________________________________________________________NIVEL ECONMICO: _______________________________________________________

RELACIN CON EL INCULPADO:SOCIAL

LABORAL

AFECTIVO O FAMILIAR

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: ( )

UTILIZO ALGN TIPO DE ARMA PARA LA COMISIN DEL DELITO?SI ( ) (POR QUE Y DE QUE TIPO) 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 CRIMINALACTUALMENTE SU:EGOCENTRISMO ES:LABILIDAD AFECTIVA:AGRESIVIDAD:INDIFERENCIA AFECTIVA:ESPECIFICAR:___________________________________________________________________________________________________________________________________________________________________________________________________________________________

PERSONALIDADTEMPERAMENTOCARACTEROLOGA

ANTISOCIAL COMPORTAMIENTO DELICTIVORESERVADO MEDITATIVO DUBITATIVO DEFENSIVO SOLICITO ABIERTO AMABLE ADAPTABLE

FCIL RELACINNERVIOSO COLRICO APASIONADO AMORFO SANGUNEOMELANCLICOFLEMTICOAPTICO

EDO. DE CONCIENCIATIPO DE DAO CAUSADOCONDUCTA REALIZADAINTENCIONALIDAD

INCONSCIENTE CONSCIENTEPERSONA PATRIMONIO MATERIALES SOCIALACCIN /OMISINDOLOSA IMPRUDENCIAL OCULPOSA

CAPACIDAD CRIMINAL:ESTADO PELIGROSO: __________________________________________________________________________________________________________________________________________________UMBRAL CRIMINAL:__________________________________________________________________________________________________________________________________________________PASO AL ACTO:__________________________________________________________________________________________________________________________________________________ADAPTABILIDAD SOCIAL EXTERNA:__________________________________________________________________________________________________________________________________________________

ADAPTABILIDAD SOCIAL INTERNA:__________________________________________________________________________________________________________________________________________________ESTADO DE PELIGROSIDAD:MNIMA ( )MNIMA MEDIA ( )MEDIA ( )MEDIA ALTA ( )ALTA ( )ESPECIFICAR:___________________________________________________________________________________________________________________________________________________________________________________________________________________________

PRONOSTICO DE REINCIDENCIA:ALTO ( )MEDIO ( ) BAJO ( )ESPECIFICAR:___________________________________________________________________________________________________________________________________________________________________________________________________________________________

VERSIN DEL DELITO:COHERENTE EN SU NARRATIVA ( ) INCOHERENTE EN SU NARRATIVA ( ) NO REFIERE VERSIN ALGUNA ( )

ENTREVISTADOR: _________________________________________________________________FECHA: ____________________________