PatientInfo

Is child enrolled in school

Yes

Intervention plan

after evaluation

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

4d3fff23-ac74-494b-be53-35c342214022

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Ashika Lodhi

Age

11 Year 4 Month 21 Days

Gender

Female

DOB

2015-01-01

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Joint

Number of family members

11

Number of siblings

4

Details of siblings (Age and sex)

14y, 8y females, 5 year male

Address

Karera, Shivpuri

Contact

9340827107

Referred By

Doctor

Informant

Father, cousin

Chief concerns

Poor understanding

Duration of symptoms

from early infancy

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

? ID with Language delay (Expressive> receptive) ? Genetic

Hopes from the consultation

Improvement in basic understanding