PatientInfo

Is child enrolled in school

No

Intervention plan

IDP 2/week + PMt 1/week. Diet as adviced.

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Home

Hospitalization

No

Tactile

PatientId

4604ff39-6a95-4d65-ad4b-1a12c048d9d6

FollowUpId

0301a47c-c122-40a0-b54e-fbf677bcba0e

Child's Name

Prasa Tomar

Age

4 Year 6 Month 3 Days

Gender

Female

DOB

2022-01-06

Mother’s age (years)

30 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

31 years

Father’s education

Father’s occupation

Farming

Type of family

Joint

Number of family members

Number of siblings

1

Details of siblings (Age and sex)

7yf, 3yf

Address

Ambah

Contact

9691495744

Referred By

Doctor

Informant

Parents

Chief concerns

Hyperactivity

Duration of symptoms

Noticed since 1 year

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Pica

Impression

? ADHD

Hopes from the consultation