PatientInfo

Is child enrolled in school

No

Intervention plan

Consanguinity

Yes

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

b563f270-f455-4f88-888c-005db1a35a81

FollowUpId

c08e1ebb-7ae4-454a-beda-a14f7bc88055

Child's Name

Sahisha

Age

4 Year

Gender

Female

DOB

2022-06-17

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

0

Details of siblings (Age and sex)

Address

Contact

7909847646

Referred By

Doctor

Informant

Parents

Chief concerns

Right side weakness of body

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Sustained

Interaction

Quality of Interaction

age-appropriate

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation