PatientInfo

Is child enrolled in school

No

Intervention plan

Home Based Program

Consanguinity

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

Yes

Tactile

Hypersensitive

PatientId

5e57c9f2-f7d4-4125-93dc-dfc7b007d72b

FollowUpId

439d0fb8-b27e-4694-a900-51a44400ef29

Child's Name

Samarth Rai

Age

2 Year 1 Month 30 Days

Gender

Male

DOB

2024-06-27

Mother’s age (years)

28 years

Mother’s education

Mother’s occupation

Banking

Father’s age (years)

29 years

Father’s education

Father’s occupation

Homemaker

Type of family

Nuclear

Number of family members

3

Number of siblings

0

Details of siblings (Age and sex)

Address

Shivpuri

Contact

9669835547

Referred By

Doctor

Informant

Parents

Chief concerns

Doesnt follow command

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Fleeting

Interaction

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

? ASD

Hopes from the consultation