Details

PatientInfo


Is child enrolled in school
Intervention plan
Consanguinity
Neck holding
Food preferences
HR
Neuropsychiatric condition
Place of Birth
Hospitalization
Tactile
PatientId
40f3440f-1b0d-479a-8100-f07d7e3a8f3e
FollowUpId
e89a9fcc-3aeb-44ef-9b5d-02a3a86afc45
Child's Name
Amar
Age
12 Year 7 Month 15 Days
Gender
Male
DOB
2013-06-13
Mother’s age (years)
40
Mother’s education
Graduate
Mother’s occupation
na
Father’s age (years)
42
Father’s education
Post Graduate
Father’s occupation
Type of family
Joint
Number of family members
Number of siblings
Details of siblings (Age and sex)
Address
Contact
09827095546
Referred By
Informant
Chief concerns
Duration of symptoms
Concerns noticed by school (if any)
Strengths of child
Eye contact
Interaction
Quality of Interaction
Repetitive behaviors (RRBs)
If yes- Details
Patterned behavior or activities
If yes- Details
Others
Details:
Impression
Hopes from the consultation

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