Details

PatientInfo


Is child enrolled in school
Intervention plan
Consanguinity
Neck holding
Food preferences
HR
Neuropsychiatric condition
Place of Birth
Hospitalization
Tactile
PatientId
2dc09acf-0b9d-427f-81b6-31875547f1f4
FollowUpId
00000000-0000-0000-0000-000000000000
Child's Name
Avantika Bhadauria
Age
13 Year 7 Month 17 Days
Gender
Female
DOB
2012-06-11
Mother’s age (years)
12
Mother’s education
Graduate
Mother’s occupation
Father’s age (years)
Father’s education
Post Graduate
Father’s occupation
Type of family
Joint
Number of family members
Number of siblings
Details of siblings (Age and sex)
Address
Contact
9825544477
Referred By
Informant
Chief concerns
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

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