PatientInfo

Is child enrolled in school

No

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

02d91d51-705e-4049-b2a6-d9ae46cee246

FollowUpId

28869f51-977d-423a-b9b8-80d8495735c0

Child's Name

Krisha Bhadoriya

Age

4 Year 4 Month 1 Days

Gender

Female

DOB

2022-03-09

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

5

Number of siblings

1

Details of siblings (Age and sex)

2 year old male

Address

Contact

9399218419

Referred By

Doctor

Informant

Parents

Chief concerns

Speech delay

Duration of symptoms

noticed since 2 years

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

GDD

Hopes from the consultation