CENTRO PENITENCIARIO DE CHIGNAHUAPAN, PUEBLA

DEPARTAMENTO DE PSICOLOGIA
INFORME PSICOLÓGICO

Datos de identificación:
Nombre de la PPL: __________________________________________________
Sobrenombre: ______________________________________________________
Sexo: _____________________________________________________________
Edad: ____________________________________________________________
Fecha de nacimiento: ________________________________________________
Lugar de nacimiento: ________________________________________________
Escolaridad intramuros: ______________________________________________
Escolaridad extramuros: ______________________________________________
Idioma: ___________________________________________________________
Dialecto: __________________________________________________________
Estado civil: ________________________________________________________
Religión: __________________________________________________________
Ocupación extramuros: _______________________________________________
Ocupación intramuros: _______________________________________________
Domicilio: _________________________________________________________
TELEFONO: s/d.
DELITO: __________________________________________________________
Instrumentos utilizados:
Entrevista- Exploración Cognoscitiva. Observación-Exploración de la personalidad.
Raven. Catarsis, test proyectivo.

Conducta durante la evaluación:

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Apariencia fisica:
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Resultados obtenidos:
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C.I. ______________________________________________________________

Exploración de la personalidad:
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Diagnóstico de personalidad:
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Sugerencia de tratamiento:

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