PatientInfo

Is child enrolled in school

Yes

Intervention plan

Home based Program

Consanguinity

Yes

Neck holding

Achieved

Food preferences

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

Hypersensitive

PatientId

ea3930ee-4b7c-4546-a894-c4dc85f08d91

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Uzaif Khan

Age

6 years

Gender

Male

DOB

2020-01-30

Mother’s age (years)

27 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

31 years

Father’s education

Father’s occupation

Job

Type of family

Joint

Number of family members

15

Number of siblings

1

Details of siblings (Age and sex)

1- 3 year old female

Address

Shivpuri

Contact

9131006431

Referred By

Doctor

Informant

Parents

Chief concerns

Hyperactivity, Delayed speech

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Fleeting

Interaction

Quality of Interaction

avoids

Repetitive behaviors (RRBs)

If yes- Details

Stymming, handfalpping

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation