PatientInfo

Is child enrolled in school

Yes

Intervention plan

Home based program

Consanguinity

Neck holding

Food preferences

Mixed

HR

Neuropsychiatric condition

Place of Birth

Hospitalization

Tactile

PatientId

fb04ed30-11ff-424d-b49b-247a3860095f

FollowUpId

a2f505e7-a5ca-4d3d-ba63-bacbd9a661c3

Child's Name

Ankush Rajavat

Age

5 Year 2 Month 18 Days

Gender

Male

DOB

2021-07-15

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Number of family members

Number of siblings

Details of siblings (Age and sex)

Address

Contact

8889626917

Referred By

Informant

Chief concerns

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

improved

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

Hand flapping

Patterned behavior or activities

If yes- Details

Others

Details:

Reduced

Impression

Hopes from the consultation