PatientInfo

Is child enrolled in school

Yes

Intervention plan

Home Based Program

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

1b811020-900f-47ea-9a5d-540a14eb854c

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Kunj Agrawal

Age

4 Year

Gender

Male

DOB

2022-09-22

Mother’s age (years)

36 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

40 years

Father’s education

Father’s occupation

Business

Type of family

Nuclear

Number of family members

3

Number of siblings

0

Details of siblings (Age and sex)

Address

Konch

Contact

6394245393

Referred By

Healthcare worker

Informant

Parents

Chief concerns

Speech delay

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Poor

Interaction

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

Hand flapping, spinning, stimming, jumping, toe walking

Patterned behavior or activities

If yes- Details

Others

Details:

Arranges objects in ques, spins wheels of toycars

Impression

ASD

Hopes from the consultation