FICHA SOCIAL

I. DATOS GENERALES
Apellidos y Nombres _________________________________ Edad _______ Religin___________
Fecha de Nacimiento ____________________ Lugar de Nac. ____________ G. de
Inst._________
Fecha de Ingreso _______________________ N Expediente ____________ Juzgado __________
Documentos PN ( ) BM ( ) DNI ( ) Ninguno ( )
Telfono________________________________
Direccin __________________________________ Referencia ____________________________
II. MOTIVOS DE INGRESO:
Especifique _____________________________________________________________________
III. SITUACIN SOCIO FAMILIAR:
3.1

Composicin Familiar

Parentesc
Nombres y Apellidos
o

3.2

Edad

Estado
Civil

Grado
Ocupaci
Acadmic
n
o

Ingresos

Tipo de Familia

Nuclear

Desintegrada

Reconstruida

Otros __________________________________________________________________
3.3

Problemtica Familiar
Violencia Familiar
Prostitucin

(
(

)
)

Drogadiccin
Delincuencia

(
(

)
)

Otros ________________________________________________________________

IV. SITUACIN ECONMICA

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

( )

( )

Anexo

( )

Piedra

( )

Comunidad

( )

Quincha

Villa
Conjunto Habitacional
Invasin
Otro

( )

( ) Unidad Agropecuaria
( )

Otros

( )

( )

( ) Madera
( )

( )

Estera

( )

Cartn

( )

Plastico

( )

Otros

( )

4.2 Cuntas personas habitan en la vivienda?

4.6 Material Predominante en los

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pisos:
Madera

( )

Cuntas habitaciones para dormir tiene?

Tierra

( )

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Cemento

( )

Otro Material

( )

4.3 Situacin que ocupa en la vivienda

4.7 Material que predomina en

Alquilada

( )

los techos:

Alquiler Venta

( )

Concreto Armado

( )

Alojada

( )

Madera

Guardiana

( )

Calamina

( )

Fibra de cemento

( )

Ocupacin de hecho
Otra Forma

( )
( )

( )

Estera

( )

Paja, caa

( )

Teja

( )

Esternit

( )

Cartn

( )

Otros materiales
4.4 El tipo de vivienda es:

( )

4.8 Cuenta con servicios Bsicos:

Casa Independiente

( )

Choza-Cabaa

( )

Luz

( )

( )

Improvisada

( )

Agua

( )

( )

Desague

( )

( )

Telfono

( )

( )

Otro

( )

Formal

Informal

V. SITUACIN DE SALUD DE LA FAMILIA

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VI. ASPECTO ECONMICO
Condicin Laboral

Ocupacin

Eventual

Obrero

( )

Empleado

Estable

( ) Comerciante

Desempleado

Otros

( )

Ingresos
( )

Padre

( ) Madre

Egresos Mensuales
( ) Alimentacin
( ) ( )

( ) Hermanos
( )

( )
Otros

Vivienda

( )

Agua

( )

( ) Luz

( )

Independiente Formal

( )
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 INTERVENCIN
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Trabajador Social

Fecha.......................................

HOGAR:
FICHA DE VISITA DOMICILIARIA

1. Datos Generales
Persona Entrevistada : _____________________________________________________________
Parentesco : _____________________________________________________________________
Tutelado (a) : ____________________________________________________________________
Direccin : _______________________________________________________________________
Motivo de la Visita : _______________________________________________________________
Fecha: __________________________________________________________________________ Hora:
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2. Situacin Encontrada
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3. Conclusiones / Sugerencias
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Trabajador Social

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Firma
Persona Entrevistada