PatientInfo

Is child enrolled in school

Intervention plan

Consanguinity

Neck holding

Food preferences

HR

Neuropsychiatric condition

Place of Birth

Hospitalization

Tactile

PatientId

ab12fe88-c636-4290-bea7-86b9222c74ac

FollowUpId

18d58a9b-16af-42c5-9a72-f374b2e618e2

Child's Name

Naina Saxena

Age

11 Month 3 Days

Gender

Female

DOB

2025-06-09

Mother’s age (years)

46

Mother’s education

Mother’s occupation

Teacher

Father’s age (years)

50

Father’s education

Father’s occupation

Private job

Type of family

Nuclear

Number of family members

3

Number of siblings

0

Details of siblings (Age and sex)

Address

Vinay Nagar

Contact

9827336861

Referred By

Doctor

Informant

Parents

Chief concerns

Unable to sit and stand

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation