PatientInfo

Is child enrolled in school

Yes

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

199c5833-915d-4c90-8ecb-ecd0415eb3e9

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Yashvi

Age

8 Year 6 Month 17 Days

Gender

Female

DOB

2017-12-12

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

6

Number of siblings

1

Details of siblings (Age and sex)

6 year old male

Address

Contact

7804083732

Referred By

Doctor

Informant

Mother

Chief concerns

Nocturnal enuresis

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

Hopes from the consultation