PatientInfo

Is child enrolled in school

Intervention plan

IDP + PT 3/week

Consanguinity

No

Neck holding

Not achieved

Food preferences

Predominantly breastfeed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

98104c62-536e-4aa6-8cc3-1bf3f5a283fb

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Shivam Kushwah

Age

11 Month 6 Days

Gender

Male

DOB

2025-10-31

Mother’s age (years)

21 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

22 years

Father’s education

Father’s occupation

Private job

Type of family

Joint

Number of family members

Number of siblings

0

Details of siblings (Age and sex)

Address

Gohad

Contact

7828053391

Referred By

Doctor

Informant

Parents

Chief concerns

Delayed milestones

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Fleeting

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

GDD. (HIE sequelae)

Hopes from the consultation