FORMATO CLINICO criminologico (ejemplo)

Fecha de estudio___________________ 

1. DA DATOS TOS GENERALES GENERALES A) PERS PERSONALES ONALES NOMBRE.-________________________________________________________  Alias.Alias.-

(SI) (SI) (NO) (NO)

Alias y razó del alias. ______________________________________________________________________________  _______________________________________ _________________________________________________  __________   ______________________________________________________________________   _______________________________________ _______________________________  E!A!.-________________

NA"IONA ONA#I!A!.-_ .-_________________________________ 

#$%AR & FE"'A !E NA"IEMIENO. ______________________________________________________________________________  _______________________________________ _________________________________________________  __________  #$%AR !E RESI!EN"IA. ______________________________________________________________________________  _______________________________________ _________________________________________________  __________  !OMI"I#IO. ______________________________________________________________________________  _______________________________________ _________________________________________________  __________  ESA!O "II#.SO#ER SO#ERO O ( ) "ASA! "ASA!O O ( )

$NI*N $NI*N #IBRE #IBRE ( )

!IOR !IOR"IA "IA!O !O ( )

I$!O I$!O ( )

"ASA 'ABIA"I*N +RO+IA ( ) RENA!A ( ) +RESA!A ( ) ORA ( ) Es,ecicar caracteristicas. ______________________________________________________________________________  _______________________________________ _________________________________________________  __________   ______________________________________________________________________________  _______________________________________ _________________________________________________  __________   N$MERO !E 'ABIANES.'ABIANES.- ____________ RE#A"I*N !E +ARENES"O. ______________________________________________________________________________  _______________________________________ _________________________________________________  __________   ______________________________________________________________________________  _______________________________________ _________________________________________________  __________  +ROFESA A#%$NA RE#I%I*N.(SI) (NO)  ______________________________________________________________________________  _______________________________________ _________________________________________________  __________   ______________________________________________________________________________  _______________________________________ _________________________________________________  __________ 

B) ANTECEDENTES ESCOLARES NIN%$NA ( ) )

+RIMARIA ( )

SE"$N!ARIA ( )

+RE+ARAORIA (

%RA!O.-__________ 

C) HISTORIA LABORAL EM+#EO +REIO A S$ !EEN"I*N. ___________________________________________________________   IEM+O.-______________________SA#ARIO. __________________________________________________  'ORARIO.______________________ 

2. SITUACIÓN LEGAL FE"'A !E IN%RESO. _______________________________________________________________________   I+O !E !E#IO. __________________________________________________________________________ 

SENEN"IA. _____________________________________________________________________  FORMA !E# !E#IO. _______________________________________________________________________ 

FORMA !E# !E#IO. _______________________________________________________________  OR%ANIA!A ( ) EN"$BRI!OR ( )

!ESOR%ANIA!O

(

)

O"ASIONA#

(

)

"#ASIFI"A"I*N "RIMIN*%ENA.+RIMO !E#IN"$ENE ( )

)

'ABI$A# (

)

REIN"I!ENE

(

ESA!O EMO"IONA# &/O F0SI"O EN E# MOMENO !E #A INFRA""I*N. ________________________________________________________________________________   ________________________________________________________________________________ 

A"I$! +OS !E#I"IA.F$%A O"$#AMIENO NE%A"I*N "INISMO ) IN!IFEREN"IA ( )

( ) ( ) ( ) ( )

ANSIE!A! ( ) ARRE+ENIMIENO ( ) "ONFESI*N ( ) ENRE%A ES+ONANEA ( (

)

SAISFA""I*N

MODUS OPERANDI

#u1ar dode se co2etió el delito  i,o de lu1ar For2a de etrada o lle1ada Moti3o a,arete Actitud o co2,orta2ieto e el hecho +eculiaridades co2etidas #u1ares 4recuetes ,ara la co2isió de la i4racció $tesilios o herra2ietas  i,o de 3icti2a Fecha e 5ue co2etió el delito  i,o de ar2a utilizada Su6ti,o de ar2a utilizada  ie2,o esti2ado e la 5ue se lle3ó a ca6o la i4racció "aracter7sticas ,articulares del hecho

FA"OR +RE!IS+ONENE A #A "OMISI*N !E# !E#IO.-

CRIMINOGÉNESIS:

Edad de iicio8_____________  Adicció a8 Alcohol y/o  a6aco Marihua a

'ero7a

"oca7a Ihalate s (es,ecic ar) Otros (es,ecic ar)

Recurreci a8 E9,eri2et al Ocasioal Social 'a6itual E9,eri2et al Ocasioal Social 'a6itual E9,eri2et al Ocasioal Social 'a6itual E9,eri2et al Ocasioal Social 'a6itual E9,eri2et al Ocasioal Social 'a6itual E9,eri2et al Ocasioal Social 'a6itual

e2,oralidad8

"atida d8 E4ecto8

E9,eri2etal Recurrete "osuetudiaria

M7i2a Media Esti2ulat e !e,resor Alta

E9,eri2etal Recurrete "osuetudiaria

M7i2a Esti2ulat Media e !e,resor Alta

E9,eri2etal Recurrete "osuetudiaria

M7i2a Esti2ulat Media e !e,resor Alta

E9,eri2etal Recurrete "osuetudiaria

M7i2a Media Esti2ulat e !e,resor Alta

E9,eri2etal Recurrete "osuetudiaria

M7i2a Esti2ulat Media e !e,resor Alta

E9,eri2etal Recurrete "osuetudiaria

M7i2a Esti2ulat Media e !e,resor Alta

ES+E"IFI"AR (RE"$RREN"IA: EM+ORA#I!A!: "ANI!A!)

 ________________________________________________________________________________   ________________________________________________________________________________   ________________________________________________________________________________   ________________________________________________________________________________   ________________________________________________________________________________  ANE"E!ENES FAMI#IARES !E# $SO !E !RO%AS  ________________________________________________________________________________   ________________________________________________________________________________   ________________________________________________________________________________ 

EXPLORACIÓN CLÍNICA:

A+ARIEN"IA F0SI"A & A"I$!.  ________________________________________________________________________________   ________________________________________________________________________________   ________________________________________________________________________________   ________________________________________________________________________________   ____________________________________________________________________________  ESIMENA 'ABI$A#.  ________________________________________________________________________________   ___________________________________________________________________________  !ES"RI+"I*N.  ________________________________________________________________________________   ________________________________________________________________________________   ___________________________________________________________________________  SI%NIFI"A!O.  ________________________________________________________________________________   ___________________________________________________________________________   A$A;ES NO ( )

SI ( ) "$
!ES"RI+"I*N8  ________________________________________________________________________________   ________________________________________________________________________________   ________________________________________________________________________________   ___________________________________________________________________________  SI%NIFI"A!O !E# MISMO8

 ________________________________________________________________________________   ________________________________________________________________________________   ___________________________________________________________________________  #O"A#IA"I*N8  ________________________________________________________________________________   ___________________________________________________________________________ 

ENFERMEDADES:

(SI)

(NO)

INFE""IONES RES+IRAORIAS %ASROINESINA#ES 'ORMONA#ES  RANSMISI*N SE=$A# +OR 'ON%OS 'EMAO#*%I"AS N$RI"IONA#ES A#ER%IAS NE$RO+SI>$IAR0AS ES+E"IFI"AR8__________________________________________________________________   ________________________________________________________________________________   ________________________________________________________________________________   ______________________________________________________________________________ 

VICTIMOLOGíA:

?. !AOS SOBRE #A I"IMA. +ERSONA MORA# ( )

+ERSONA F0SI"A ( )

SE=O & E!A!8 ____________________________________________________________  NIE# E"ON*MI"O8 _______________________________________________________ 

RE#A"I*N "ON E# IN"$#+A!O8 SO"IA# #ABORA# AFE"IO O FAMI#IAR ES+E"IFI"AR8  ________________________________________________________________________________   ___________________________________________________________________________  "ONSE"$EN"IAS !E# I#0"IO EN RE#A"I*N "ON #A I"IMA8  ________________________________________________________________________________   ___________________________________________________________________________ 

CRIMINODIAGNOSTICO.

"ARA"ER0SI"AS !E +ERSONA#I!A! RE#A"IONA!AS "ON E# !E#IO (>$E SE "ONSI!ERAN RE#EANES +ARA INF#$IR EN S$ +RO"ESO !E REIN"OR+ORA"I*N SO"IA#)  ________________________________________________________________________________   ________________________________________________________________________________   ________________________________________________________________________________   ________________________________________________________________________________   ___________________________________________________________________________  "RIMINO%@NESIS (FA"ORES BIO#*%I"OS: +SI"O#*%I"OS & SO"IA#ES >$E FAORE"EN #A "OMISI*N !E# !E#IO) FA"ORES +SI"O"RIMINO%ENOS8 Edó1eos8__________________________________________________________________  E9ó1eos ,re,arates8________________________________________________________ 

o

!esecadeates8 ____________________________________________________________ 

CRIMINODINAMIA:

"A$SA "RIMIN*%ENA8__________________________________________________________  M*I# "RIMIN*%ENO8_________________________________________________________  FA"OR "RIMIN*%ENO8________________________________________________________  CAPACIDAD CRIMINAL:

ESA!O +E#I%ROSO8  _________________________________________________________________________   _________________________________________________________________________  A!A+ABI#I!A! SO"IA# E=ERNA8  _________________________________________________________________________   _________________________________________________________________________ 

A!A+ABI#I!A! SO"IA# INERNA8  _________________________________________________________________________   _________________________________________________________________________  ESA!O !E +E#I%ROSI!A!8 M0NIMA ( )

M0NIMA ME!IA ( )

ME!IA A#A ( )

A#A ( )

ME!IA ( )

ES+E"IFI"AR8  _________________________________________________________________________   _________________________________________________________________________   _________________________________________________________________________ 

+RONOSI"O !E REIN"I!EN"IA8 A#O ( )

ME!IO ( )

BA;O ( )

ES+E"IFI"AR8  _________________________________________________________________________   _________________________________________________________________________   _________________________________________________________________________