PatientInfo

Is child enrolled in school

No

Intervention plan

IDP 2/week + PMT 1/week

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed. Prefers mashed food

HR

Neuropsychiatric condition

Place of Birth

Institutional

Hospitalization

Yes

Tactile

Hyposensitive

PatientId

e8f97228-063f-4d28-ad74-aedbdb2a0bf7

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Mohammad Roman

Age

3 Year 6 Month 8 Days

Gender

Male

DOB

2022-11-24

Mother’s age (years)

26 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

29 years

Father’s education

Father’s occupation

Tailor

Type of family

Joint

Number of family members

4

Number of siblings

1

Details of siblings (Age and sex)

1.5 year male

Address

Guda gudi ka naka

Contact

9131164576

Referred By

Doctor

Informant

Parents

Chief concerns

Poor response to name call

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Fleeting

Interaction

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

Handflapping, running to and fro, stimming

Patterned behavior or activities

If yes- Details

Others

Details:

Chewing of toys

Impression

ASD. HIE sequelae

Hopes from the consultation