PatientInfo

Is child enrolled in school

Yes

Intervention plan

To be decided after evaluation

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

Yes

Tactile

PatientId

9502b378-7d51-4b65-91b1-3d7f7ece7d29

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Raj Sirothiya

Age

12 Year 3 Month 12 Days

Gender

Male

DOB

2014-02-01

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Nuclear

Number of family members

4

Number of siblings

1

Details of siblings (Age and sex)

8 months

Address

Sagartal, Gwl

Contact

9098165065

Referred By

Doctor

Informant

Parents

Chief concerns

Stuttering

Duration of symptoms

Since 5 years age

Concerns noticed by school (if any)

Strengths of child

Social interaction

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

Stuttering

Hopes from the consultation