PatientInfo

Is child enrolled in school

No

Intervention plan

IDP 2/week + PMT 1/week

Consanguinity

No

Neck holding

Achieved

Food preferences

Picky eater

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

3ba7310c-fcd6-4ab0-8d17-b769a9aa74fb

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Mohammad Mohiuddin

Age

2 Year 2 Month 12 Days

Gender

Male

DOB

2024-04-15

Mother’s age (years)

30 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

38 years

Father’s education

Father’s occupation

NGO

Type of family

Nuclear

Number of family members

3

Number of siblings

Details of siblings (Age and sex)

Address

Kampoo

Contact

8269626901

Referred By

Doctor

Informant

Parents

Chief concerns

Speech delay

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

Hand flapping, spinning, looking from lateral side of eyes

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

? ASD. M chat r score- 17 (High risk)

Hopes from the consultation