PatientInfo

Is child enrolled in school

No

Intervention plan

Home strategies adviced

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

Yes

Tactile

PatientId

45bf24ee-e7b9-405b-9cf2-6b70405a0478

FollowUpId

02cbf426-8f41-43a5-8cde-0fb0ba62b99c

Child's Name

Prince Ojha

Age

10 Year 2 Month 23 Days

Gender

Male

DOB

2016-06-09

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

12

Number of siblings

2

Details of siblings (Age and sex)

8 year female, 6 year male

Address

Contact

6353517687

Referred By

Doctor

Informant

Father, maternal uncle

Chief concerns

Poor understanding

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Sustained

Interaction

Quality of Interaction

age-appropriate

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

?ID

Hopes from the consultation