PatientInfo

Is child enrolled in school

Intervention plan

Early stimulation adviced

Consanguinity

No

Neck holding

Not achieved

Food preferences

On formula feed. topfeed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

78f2afc5-881d-4576-803f-8687a1748e0e

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Shriya Chauhan

Age

4 Month 19 Days

Gender

Female

DOB

2026-06-04

Mother’s age (years)

24 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

24 years

Father’s education

Father’s occupation

Private job

Type of family

Joint

Number of family members

3

Number of siblings

0

Details of siblings (Age and sex)

Address

Contact

7355482050

Referred By

Doctor

Informant

Parents

Chief concerns

3

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation