Details

PatientInfo


Is child enrolled in school
Yes
Intervention plan
IDP 1/week + PMT 1/week
Consanguinity
Neck holding
Food preferences
Mixed
HR
Neuropsychiatric condition
Place of Birth
Hospitalization
Tactile
PatientId
ab38d334-860c-4ae1-ace5-b6da963abdd2
FollowUpId
55b0d6c2-5916-4f5c-89c4-81c39c1c0c78
Child's Name
Ishan Sharma
Age
3 Year 11 Month 13 Days
Gender
Male
DOB
2022-11-06
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
6232914812
Referred By
Informant
Chief concerns
Duration of symptoms
Concerns noticed by school (if any)
Strengths of child
Eye contact
Fleeting
Interaction
Quality of Interaction
limited
Repetitive behaviors (RRBs)
If yes- Details
Patterned behavior or activities
If yes- Details
Others
Details:
Impression
?ASD
Hopes from the consultation

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