PatientInfo

Is child enrolled in school

Yes

Intervention plan

IDP 2/week + PMT 1/week

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

37418616-2c2b-49f8-9d7c-a46e425ffc4e

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Amogh Bajpay

Age

3 Year 4 Month 11 Days

Gender

Male

DOB

2023-05-28

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

Number of siblings

2

Details of siblings (Age and sex)

6 year old, 2nd -twin

Address

City centre

Contact

9131430076

Referred By

Doctor

Informant

Parents

Chief concerns

Speech delay

Duration of symptoms

Noted since 4 months

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

Prefers being isolated

Quality of Interaction

avoids

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

? ASD

Hopes from the consultation