PatientInfo

Is child enrolled in school

Yes

Intervention plan

After evaluation

Consanguinity

No

Neck holding

Achieved

Food preferences

Picky eating

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

Yes

Tactile

PatientId

dca99f36-c27b-4333-9a1c-359517398e8f

FollowUpId

5ae1cf70-e8fa-4500-90af-b38ef1426abd

Child's Name

Gayu Bansal

Age

7 Year 1 Month 26 Days

Gender

Female

DOB

2019-07-21

Mother’s age (years)

30 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

40 years

Father’s education

Father’s occupation

business

Type of family

Joint

Number of family members

5

Number of siblings

2

Details of siblings (Age and sex)

3.5 year old male, 11 year old female

Address

Joura

Contact

7566971550

Referred By

Doctor

Informant

Father

Chief concerns

Understanding not at par age, poor appetite

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

Hopes from the consultation