PatientInfo

Is child enrolled in school

Yes

Intervention plan

IQ evaluation. Session to be planned accordingly

Consanguinity

No

Neck holding

Achieved

Food preferences

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

Yes

Tactile

PatientId

bb14051d-7f39-4509-a6bc-b52f6ccc1484

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Aasma Jatav

Age

6 Year 3 Month 27 Days

Gender

Female

DOB

2019-11-17

Mother’s age (years)

31 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

29 years

Father’s education

Father’s occupation

Private job

Type of family

Joint

Number of family members

5

Number of siblings

2

Details of siblings (Age and sex)

1- 4.5 year female, 2- 3 year male

Address

Sabalgarh

Contact

9993491372

Referred By

Doctor

Informant

Chief concerns

Poor understanding, stubborness

Duration of symptoms

Concerns since early childhood

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:

Impression

Hopes from the consultation