Details

PatientInfo


Is child enrolled in school
Intervention plan
Consanguinity
Neck holding
Food preferences
HR
Neuropsychiatric condition
Place of Birth
Hospitalization
Tactile
PatientId
00000000-0000-0000-0000-000000000000
FollowUpId
0c5d0457-3a71-4f4e-895f-ff49ad19afa5
Child's Name
Kunal Jain
Age
14 Year
Gender
Male
DOB
2012-01-17
Mother’s age (years)
30
Mother’s education
Graduate
Mother’s occupation
HF
Father’s age (years)
50
Father’s education
Graduate
Father’s occupation
Type of family
Number of family members
Number of siblings
Details of siblings (Age and sex)
Address
Contact
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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