PatientInfo

Is child enrolled in school

Yes

Intervention plan

IDP 1/week + PMT 1/week

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed (doesnt est fruit)

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

11ccac86-34c3-47ee-b47c-9e3d7df83c17

FollowUpId

c2fe18f9-0853-497e-aa3e-91549aa4996a

Child's Name

Madhav Yadav

Age

3 Year 4 Month 9 Days

Gender

Male

DOB

2022-12-25

Mother’s age (years)

30 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

37 years

Father’s education

Father’s occupation

Govt job

Type of family

Joint

Number of family members

4

Number of siblings

1

Details of siblings (Age and sex)

7 year old female

Address

Badagaon

Contact

7898897842

Referred By

Doctor

Informant

Parents

Chief concerns

Clarity of speech

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