PatientInfo

Is child enrolled in school

Yes

Intervention plan

after evaluation

Consanguinity

No

Neck holding

Achieved

Food preferences

Picky eater

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

b9b26b6d-6bcb-48e1-a5da-8922f4468877

FollowUpId

a2173fe9-dc51-4a77-881a-185cee873ebc

Child's Name

Dishani Sagoriya

Age

5 Year 10 Month 15 Days

Gender

Female

DOB

2020-08-08

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Joint

Number of family members

8

Number of siblings

1

Details of siblings (Age and sex)

1- 3.5 year male

Address

Dabra

Contact

8770188422

Referred By

Doctor

Informant

Parents

Chief concerns

Unclear speech

Duration of symptoms

Since initiation of speech

Concerns noticed by school (if any)

Strengths of child

Eye contact

Sustained

Interaction

Quality of Interaction

age-appropriate

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Fidgetiness

Impression

Poor self regulation, Misarticulation+

Hopes from the consultation