PatientInfo

Is child enrolled in school

No

Intervention plan

IDP 2/week

Consanguinity

Neck holding

Food preferences

Mixed

HR

Neuropsychiatric condition

Place of Birth

Hospitalization

Tactile

PatientId

ed94098c-f242-4086-9096-a450421bb936

FollowUpId

e0a1072f-58f7-4105-aa17-221df6ae828d

Child's Name

Shiva Tomar

Age

4 Year 9 Month 18 Days

Gender

Male

DOB

2021-07-17

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Number of family members

Number of siblings

Details of siblings (Age and sex)

Address

Contact

7489177440

Referred By

Informant

Chief concerns

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Object obsession reduced, stubborness +

Impression

ASD

Hopes from the consultation