PatientInfo

Is child enrolled in school

No

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

Yes

Tactile

PatientId

c58fe8c6-8c13-42b2-a12c-abb84223e575

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Dhairya Sen

Age

4 Year 5 Month 26 Days

Gender

Male

DOB

2021-12-08

Mother’s age (years)

31 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

40 years

Father’s education

Father’s occupation

Teacher

Type of family

Nuclear

Number of family members

4

Number of siblings

1

Details of siblings (Age and sex)

13 year female

Address

Bina

Contact

9685629982

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

Suboptimal

Interaction

Likes to play with kids who are known

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation