PatientInfo

Is child enrolled in school

Yes

Intervention plan

VSMS, ISAA, DSM5 ASD

Consanguinity

No

Neck holding

Achieved

Food preferences

Picky eating

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

d7bbee2a-58c3-4931-885a-94bd5f44893c

FollowUpId

28ed2e54-8051-44da-a62e-733ef7f775ec

Child's Name

Angad Kansana

Age

3 Year 6 Month 4 Days

Gender

Male

DOB

2022-08-20

Mother’s age (years)

42 years

Mother’s education

Mother’s occupation

Father’s age (years)

48 years

Father’s education

Father’s occupation

Business

Type of family

Number of family members

Number of siblings

3

Details of siblings (Age and sex)

1- 22y f, 2- 17y f, 3- 5y m

Address

Madhavnagar

Contact

9301250174

Referred By

Doctor

Informant

Mother

Chief concerns

Clarity of speech

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Jumping

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation