PatientInfo

Is child enrolled in school

Yes

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

No

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

63873db4-4997-4213-8276-541653c950bc

FollowUpId

e4780d1b-b2b8-4087-a810-ec8e69dc2f21

Child's Name

Manvik

Age

3 Year 4 Month 21 Days

Gender

Male

DOB

2022-10-21

Mother’s age (years)

29 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

33 years

Father’s education

Father’s occupation

Govt job

Type of family

Joint

Number of family members

4

Number of siblings

0

Details of siblings (Age and sex)

Address

Darpan

Contact

9660622484

Referred By

Doctor

Informant

Chief concerns

Speech delay

Duration of symptoms

Noticed 2.5 years

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

wants to engage with children

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Object obsession

Impression

Hopes from the consultation