PatientInfo

Is child enrolled in school

No

Intervention plan

IDP 2/week + PMT/week

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed. Bottlefeeding+

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

Hypersensitive

PatientId

1d174b88-cb4c-40e4-b13d-13e0c37ac9f8

FollowUpId

6b34b8eb-be33-46fa-83a5-ccd116fcab89

Child's Name

Shivansh Singh

Age

2 Year 5 Month 6 Days

Gender

Male

DOB

2024-02-09

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Number of family members

Number of siblings

Details of siblings (Age and sex)

Address

Contact

8878088678

Referred By

Informant

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

Patterned behavior or activities

If yes- Details

Others

Details:

Obsessed by vehicle toys

Impression

Hopes from the consultation