Details

PatientInfo


Is child enrolled in school
Yes
Intervention plan
Home startegies adviced. Plan to be given after evaluation.
Consanguinity
No
Neck holding
Achieved
Food preferences
Mixed
HR
Neuropsychiatric condition
No
Place of Birth
Institutional
Hospitalization
Yes
Tactile
PatientId
d710531b-01bf-459b-8cba-983a8c674014
FollowUpId
00000000-0000-0000-0000-000000000000
Child's Name
Kuldeep Sharma
Age
12 Year 4 Month 21 Days
Gender
Male
DOB
2013-12-10
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
3
Details of siblings (Age and sex)
1nd- 17y, 2nd- 15 y. 3rd-14y (females)
Address
Joura
Contact
7999884752
Referred By
Doctor
Informant
Parents
Chief concerns
Stammering
Duration of symptoms
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:
Impression
Stuttering
Hopes from the consultation

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