PatientInfo

Is child enrolled in school

Yes

Intervention plan

IQ/DQ evaluation

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

67ef8f1d-d08e-4fe0-847d-4dc389c14df1

FollowUpId

7c3ba3f1-5cd3-4a25-af58-89475b0efa78

Child's Name

Vedant Panchkar

Age

10 Year 3 Month 3 Days

Gender

Male

DOB

2016-04-03

Mother’s age (years)

28 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

30 years

Father’s education

Father’s occupation

Labourer

Type of family

Joint

Number of family members

5

Number of siblings

3

Details of siblings (Age and sex)

7yf,4yf,3mM

Address

Damoh

Contact

8839644663

Referred By

Doctor

Informant

Father

Chief concerns

Poor understanding

Duration of symptoms

Realized at 4 years age

Concerns noticed by school (if any)

Strengths of child

Eye contact

Sustained

Interaction

Wants to interact but inappropriate approach

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Hand flapping

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

ID

Hopes from the consultation