PatientInfo

Is child enrolled in school

Intervention plan

Consanguinity

No

Neck holding

Food preferences

Vegetarian

HR

Neuropsychiatric condition

Place of Birth

Institutional

Hospitalization

No

Tactile

Hyposensitive

PatientId

00000000-0000-0000-0000-000000000000

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Jasmin Thomas

Age

23 Year

Gender

Female

DOB

2003-01-06

Mother’s age (years)

45

Mother’s education

Post Graduate

Mother’s occupation

House Wife

Father’s age (years)

50

Father’s education

Graduate

Father’s occupation

Private Job

Type of family

Joint

Number of family members

5

Number of siblings

5

Details of siblings (Age and sex)

NA

Address

Ekta Vihar Colony Kampoo Lashkar Gwalior-474001 M.P.

Contact

9858095500

Referred By

Doctor

Informant

NA

Chief concerns

No Chief Concerns

Duration of symptoms

10

Concerns noticed by school (if any)

Nothing

Strengths of child

Good

Eye contact

Sustained

Interaction

No Interaction

Quality of Interaction

avoids

Repetitive behaviors (RRBs)

If yes- Details

Repetitive behaviors (RRBs)

Patterned behavior or activities

If yes- Details

Patterned behavior or activities

Others

Details:

Others Behavior History Details

Impression

Impression

Hopes from the consultation

Hopes from the consultation