Ancheta Psihosociala Tipizat

NR.
__________________________
ANCHETA CURATELA
Realizata
inspectorii:__________________________________________________________________________________
Locul
si
___________________________________________________________________________________________
de
data:
Persoane
prezente:______________________________________________________________________________________
Scopul:________________________________________________________________________________________________
DATE DESPRE FAMILIE

A. Date despre mama
Nume
prenume:___________________________________________________________________________________
Locul
si
nasterii:__________________________________________________________________________________
si
data
CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/
Domiciliul
legal:_______________________________________________________________________________________
Stare
sanatate:_____________________________________________________________________________________
Situatia
socio
profesionala:____________________________________________________________________________
de
____________________________________________________________________________________________________
Loc
munca:________________________________________________________________________________________
de
Venituri:___________________________________________________________________________________________
_
Informatii
relevante:___________________________________________________________________________________
____________________________________________________________________________________________________
___________________________________________________________________________________________________
B. Date despre tata

Nume
prenume:__________________________________________________________________________________
si
Locul
si
nasterii:___________________________________________________________________________________
data
CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/
Domiciliul
legal:_______________________________________________________________________________________
Stare
sanatate:_____________________________________________________________________________________
de
Situatia
socio
profesionala:____________________________________________________________________________
____________________________________________________________________________________________________
Loc
munca:________________________________________________________________________________________
de
Venituri:___________________________________________________________________________________________
__
Informatii
relevante:___________________________________________________________________________________
___________________________________________________________________________________________________
__________________________________________________________________________________________________
DATE DESPRE COPII (BENEFICIARI)

Nume
prenume:____________________________________________________________________________________
Locul
si
nasterii:___________________________________________________________________________________
CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/
si
data
Situatie
socio
profesionala:____________________________________________________________________________
Scoala
liceul:________________________________________________________________________________________
Venituri:___________________________________________________________________________________________
__
Informatii
relevante:___________________________________________________________________________________
____________________________________________________________________________________________________
__________________________________________________________________________________________________
Nume
prenume:____________________________________________________________________________________
Locul
si
nasterii:__________________________________________________________________________________
si
data
CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/
Situatie
socio
profesionala:____________________________________________________________________________
Scoala
liceul:________________________________________________________________________________________
Venituri:___________________________________________________________________________________________
__
Informatii
relevante:___________________________________________________________________________________
____________________________________________________________________________________________________
___________________________________________________________________________________________________
Nume
prenume:____________________________________________________________________________________
Locul
si
nasterii:_________________________________________________________________________________
si
data
CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/
Situatie
socio
profesionala:__________________________________________________________________________
Scoala
liceul:_______________________________________________________________________________________
Venituri:___________________________________________________________________________________________
_
Informatii
relevante:_________________________________________________________________________________
__________________________________________________________________________________________________
___________________________________________________________________________________________________
DATE DESPRE CURATOR/TUTORE

Nume
prenume:_________________________________________________________________________________
Locul
si
nasterii:_______________________________________________________________________________
si
data
CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/
Domiciliul
legal:____________________________________________________________________________________
Starea
sanatate:___________________________________________________________________________________
de
Situatie
socio
profesionala:___________________________________________________________________________
Locul
munca:_______________________________________________________________________________________
de
Venituri:___________________________________________________________________________________________
_
Informatii
relevante:__________________________________________________________________________________
___________________________________________________________________________________________________
__________________________________________________________________________________________________
DATE DESPRE IMOBIL

Adresa:____________________________________________________________________________________________
Proprietar:_________________________________________________________________________________________
__
Nume
camera:____________________________________________________________________________________
de
Stare
igiena:______________________________________________________________________________________
de
Mobilier:___________________________________________________________________________________________
_
Conditii
locuit:_____________________________________________________________________________________
de
Utilitati:__________________________________________________________________________________________
ISTORIC FAMILIAL
RELEVANT
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
__________________________________________________________________________________________________
DESCRIEREA SITUATIEI ACTUALE

____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
OBSERVATII SI RECOMANDARI
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
___________________________________________________________________________________________________
Data:__________________
Semnatura
___________________
___________________

Ancheta Psihosociala Tipizat

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Ancheta Psihosociala Tipizat

Încărcat de

Drepturi de autor:

Formate disponibile

NR.

DATE DESPRE FAMILIE

B. Date despre tata

DATE DESPRE COPII (BENEFICIARI)

DATE DESPRE CURATOR/TUTORE

DATE DESPRE IMOBIL

DESCRIEREA SITUATIEI ACTUALE

S-ar putea să vă placă și