PatientInfo

Is child enrolled in school

Yes

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

Place of Birth

Institutional

Hospitalization

Yes

Tactile

PatientId

a4a63e37-1792-4f11-9a71-bf34560835ce

FollowUpId

d8323ab0-32fe-4a23-832a-9e2753a7da98

Child's Name

Ved Rajput

Age

12 Year 10 Month 6 Days

Gender

Male

DOB

2013-11-20

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Nuclear

Number of family members

4

Number of siblings

1

Details of siblings (Age and sex)

17 year old male

Address

Jhansi

Contact

9452600201

Referred By

Doctor

Informant

Parents

Chief concerns

Poor understanding

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Fidgetiness+

Impression

ID

Hopes from the consultation