PatientInfo

Is child enrolled in school

No

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

8d65363c-befc-4790-981c-1b0fcf6e4726

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Adika Jha

Age

3 Year 2 Month 10 Days

Gender

Female

DOB

2023-02-01

Mother’s age (years)

36 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

36 years

Father’s education

Father’s occupation

Pvt job

Type of family

Nuclear

Number of family members

4

Number of siblings

1

Details of siblings (Age and sex)

8 year old female

Address

Ashok Nagar

Contact

6266058872

Referred By

Doctor

Informant

Mother

Chief concerns

Delayed development

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Sustained

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Head banging, attention seeking

Impression

GDD

Hopes from the consultation