PatientInfo

Is child enrolled in school

Yes

Intervention plan

IEP 3/week + PMT 1/week

Consanguinity

Neck holding

Food preferences

Mixed

HR

Neuropsychiatric condition

Place of Birth

Hospitalization

Tactile

PatientId

7542d145-5278-4a4c-a366-60004b88284e

FollowUpId

eaf10af3-2e93-4622-ab8d-a6c6dac9bd4f

Child's Name

Suryansh Rathore

Age

9 Year 2 Month 27 Days

Gender

Male

DOB

2017-07-16

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

7000609314

Referred By

Informant

Chief concerns

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

Improved

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Uses offensive words when angry

Impression

Hopes from the consultation