PatientInfo

Is child enrolled in school

No

Intervention plan

IDP 1/week + PMT 1/week

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

cba1aed4-104f-4182-8da2-24c5ae74d244

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Prince Soni

Age

5 Year 7 Month 13 Days

Gender

Male

DOB

2021-01-05

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Joint

Number of family members

9

Number of siblings

0

Details of siblings (Age and sex)

Address

Tikamgarh

Contact

6268893295

Referred By

Doctor

Informant

Parents, uncle

Chief concerns

Speech delay

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

Hand flapping, toe walking, looking from corner of eye

Patterned behavior or activities

If yes- Details

Others

Details:

throwing objects

Impression

?ID

Hopes from the consultation