PatientInfo

Is child enrolled in school

Yes

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Picky eater

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

6c52c407-2add-4e93-b6d2-a5b15ae13379

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Gunav

Age

5 Year 10 Month 22 Days

Gender

Male

DOB

2020-09-28

Mother’s age (years)

40 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

42 years

Father’s education

Father’s occupation

Business

Type of family

Joint

Number of family members

5

Number of siblings

0

Details of siblings (Age and sex)

Address

Chetakpuri

Contact

9410477727

Referred By

Doctor

Informant

Mother

Chief concerns

Behavioral concerns

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

Behavioral dysregulation

Hopes from the consultation