PatientInfo

Is child enrolled in school

Yes

Intervention plan

Consanguinity

No

Neck holding

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

Yes

Tactile

PatientId

36ed390b-3836-474a-8062-3c4987069552

FollowUpId

eee98b2e-0f6a-41a1-9f3e-1856bf475c37

Child's Name

Abhibhav Mishra

Age

12 Year 6 Month 18 Days

Gender

Male

DOB

2013-12-11

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

Number of siblings

1

Details of siblings (Age and sex)

10 year old male

Address

Orai

Contact

9450014572

Referred By

Relative

Informant

Father, uncle

Chief concerns

Short stature

Duration of symptoms

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

Stunting, Underweight

Hopes from the consultation