Details

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
9277fa18-6a66-44b5-8c38-930b40b8f51c
FollowUpId
a3486b2b-29d5-4ec4-b98f-70c30af70bf9
Child's Name
Jay
Age
3 Year 3 Month 14 Days
Gender
Male
DOB
2023-02-25
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
9589455898
Referred By
Doctor
Informant
Parents
Chief concerns
Object oriented
Duration of symptoms
Concerns noticed by school (if any)
Strengths of child
Eye contact
Suboptimal
Interaction
Plays with kids
Quality of Interaction
age-appropriate
Repetitive behaviors (RRBs)
If yes- Details
Patterned behavior or activities
If yes- Details
Others
Details:
wears clothes of his choice, spins wheels of car sometimes, destructive play
Impression
Hopes from the consultation

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