PatientInfo

Is child enrolled in school

Yes

Intervention plan

To be decided after evaluation

Consanguinity

Neck holding

Food preferences

Mixed

HR

Neuropsychiatric condition

Place of Birth

Hospitalization

Tactile

PatientId

ec2ce2ce-ecd3-41dc-9594-90b8088edb64

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Nikhil Kehrvar

Age

9 Year 8 Month 5 Days

Gender

Male

DOB

2016-08-25

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

Details of siblings (Age and sex)

Address

Contact

8964958682

Referred By

Informant

Chief concerns

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

Avoids interaction due to low self esteem

Quality of Interaction

avoids

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Improvement in understanding after home strategies

Hopes from the consultation