PatientInfo

Is child enrolled in school

No

Intervention plan

IDP 3/week + PMT 1/15 days

Consanguinity

Neck holding

Food preferences

Mixed

HR

Neuropsychiatric condition

Place of Birth

Hospitalization

Tactile

PatientId

bd060c5e-162f-4fb6-8a39-608e4b7018bd

FollowUpId

86b6cc83-6a11-4cea-a607-4a5ee39da7e6

Child's Name

Dharvi Singh

Age

3 Year 1 Month 7 Days

Gender

Female

DOB

2023-07-03

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Number of family members

Number of siblings

Details of siblings (Age and sex)

Address

Contact

7987853809

Referred By

Informant

Chief concerns

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Fleeting

Interaction

Improved with family members

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation