FICHA SOCIAL

I.DATOS GENERALES
Apellidos y Nombres ___________________________________________ Edad _______________________
Fecha de Nacimiento____________________________ Lugar de Nac. _______________________________
G. De Instruccin ____________________________ Fecha de Ingreso _____________________________
Juzgado _______________________________ Nmero de Identidad _______________________________
Tlefono_____________________________ Direccin ___________________________________________

II. MOTIVOS DE INGRESO

Especifique ______________________________________________________________________________
III.SITUACION SOCIOFAMILIAR
3.1 Composicin Familiar

No.

Nombre y Apellidos

Parentesco

Sexo

Grado
Acadmico

Edad

Estado Civil

Ocupacin

3.2 Tipo de Familia

Nuclear
(
)
Desintegrada
(
)
Recontruida
(
)
Otros __________________________________________________________________

3.3 Problemtica Familiar

Violencia Familiar
(
)
Drogadiccin
(
)
Prostitucin
(
)
Delincuencia
(
)
Otros __________________________________________________________________

Ingreso

IV. SITUACION ECONOMICA

4.1 Ubicacin de la vivienda
1.- Zona Urbana

2.- Zona Rural

4.5.- Material Predominante en las

Ciudad

Pueblo

paredes:

AA HH

Poblado

Ladrillo

Asociacin vivienda

Casero

Adobe

Villa

Anexo

Piedra

Conjunto Habitacional

Comunidad

Quincha

Invansin

Unidad Agropecuaria

Madera

Otro

Otros

Estera

Cartn

Plstico

Otros

4.6.- Material Predominante en los

4.2.- Cuntas personas habitan en la vivienda?

pisos:

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Madera

Cuntas habitaciones para dormir tiene?

Tierra

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Cemento

Otro material

4.3.- Situacin que ocupa en la vivienda

Alquilada

Alquiler Venta

Alojada

Guardiana

Ocupacin de hecho

Propia

Otra forma

4.4.- El tipo de vivienda es:

4.7.- Material que predomina en los

techos:
Concreto Armado

Madera

Calamina

Fibra de cemento

Estera

Paja, caa

Teja

Cartn

Esternit

Otra forma

4.8.- Cuenta con Servicios Bsicos:

Casa Independiente

Formal

Informal

Choza-Cabaa

Luz

Improvisada

Agua

Otro

Desague

Telfono

V.SITUACION DE SALUD DE LA FAMILIA

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VI. ASPECTO ECONOMICO
Condicin Laboral

Ocupacin

Ingresos

Egresos Mensuales

Eventual

Obrero

Padre

Alimentacin

Estable

Empleado

Madre

Vivienda

Desempleado

Comerciante

Hermanos

Agua

Independiente Formal

Otros

Otros

Luz

Independiente Informal (

Otros

Observacin
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VII. HISTORIA FAMILIAR
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VIII. ESTRUCTURA Y DINAMICA FAMILIAR

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IX. DIAGNOSTICO SOCIAL
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X. PLAN DE INTERVENCION
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Psicologa

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Fecha

FICHA DE VISITA DOMICILIARIA

Hogar: __________________________________________________________________________
Datos Generales
Persona Entrevistada: ______________________________________________________________
Parentesco: ______________________________________________________________________
Tutelado (a): _____________________________________________________________________
Direccin: _______________________________________________________________________
Motivo de la visita: ________________________________________________________________
Fecha: __________________________________________________________________________
Hora: ___________________________________________________________________________
Situacin Encontrada
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Conclusiones/Sugerencias
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Psicologa

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Persona Entrevistada