PatientInfo

Is child enrolled in school

No

Intervention plan

HBP

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

2358da60-9f16-4460-8482-6371b90be517

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Kanha Sharma

Age

3 Year

Gender

Male

DOB

2023-08-06

Mother’s age (years)

35 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

35 years

Father’s education

Father’s occupation

Private job

Type of family

Nuclear

Number of family members

3

Number of siblings

1

Details of siblings (Age and sex)

10 year old female

Address

Jaipur

Contact

8000028129

Referred By

Doctor

Informant

Parents

Chief concerns

Speech delay, behavioral concerns

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

running to and fro, head nodding

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

? ASD. M chat- 11

Hopes from the consultation