PatientInfo

Is child enrolled in school

Yes

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

44b21270-937a-4ac2-b64c-8da4e61ac1a9

FollowUpId

f235baff-343f-4b2a-b1ee-d3ee4801df08

Child's Name

Arpit Rathore

Age

9 Year

Gender

Male

DOB

2017-07-07

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Joint

Number of family members

6

Number of siblings

1

Details of siblings (Age and sex)

12 year old male

Address

Jalon

Contact

8317007305

Referred By

Healthcare worker

Informant

Parents

Chief concerns

Speech delay

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Sustained

Interaction

Takes time to initiate interaction with new people

Quality of Interaction

age-appropriate

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Screaming

Impression

Language delay

Hopes from the consultation