PatientInfo

Is child enrolled in school

Intervention plan

Home strategies adviced for early stimulation

Consanguinity

No

Neck holding

Not achieved

Food preferences

EBF

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

61e5c34b-158e-4fb3-b804-9cb57a94e92a

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Aarav

Age

5 Month 10 Days

Gender

Male

DOB

2026-05-07

Mother’s age (years)

27 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

31 years

Father’s education

Father’s occupation

Private job

Type of family

Joint

Number of family members

4

Number of siblings

Details of siblings (Age and sex)

Address

Morena

Contact

9753777744

Referred By

Doctor

Informant

Parents

Chief concerns

Doesnt fixate vision

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

Hopes from the consultation