PatientInfo

Is child enrolled in school

No

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed eater

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

Yes

Tactile

PatientId

41f3a274-44b0-40af-9095-aa2f3a9f0899

FollowUpId

6657b247-8148-42be-93fa-10bc197664d5

Child's Name

Kashvi Bhadoriya

Age

3 Year

Gender

Female

DOB

2023-06-25

Mother’s age (years)

35 years

Mother’s education

Mother’s occupation

Govt job (Professor)

Father’s age (years)

38 years

Father’s education

Father’s occupation

Construction

Type of family

Joint

Number of family members

5

Number of siblings

1

Details of siblings (Age and sex)

8 year old female

Address

Gole ka mandir

Contact

9755883488

Referred By

Doctor

Informant

Parents

Chief concerns

Speech delay

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

Expressive speech delay

Hopes from the consultation