PatientInfo

Is child enrolled in school

Yes

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

7542d145-5278-4a4c-a366-60004b88284e

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Suryansh Rathore

Age

9 Year

Gender

Male

DOB

2017-07-16

Mother’s age (years)

33 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

42 years

Father’s education

Father’s occupation

Service

Type of family

Nuclear

Number of family members

4

Number of siblings

1

Details of siblings (Age and sex)

5 year old male

Address

Govindpuri

Contact

7000609314

Referred By

Doctor

Informant

Parents

Chief concerns

Academic concerns

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

Quality of Interaction

avoids

Repetitive behaviors (RRBs)

If yes- Details

Hand flapping

Patterned behavior or activities

If yes- Details

Others

Details:

Fidgetiness +. Object oriented.

Impression

? SLD

Hopes from the consultation