PatientInfo

Is child enrolled in school

No

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed. Bottlefeeding.

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

Yes

Tactile

PatientId

9c2682d4-304e-4f49-95c4-de4a649c86ae

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Vinayak singh Tomar

Age

3 Year 7 Month 18 Days

Gender

Male

DOB

2022-11-29

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

4

Number of siblings

1

Details of siblings (Age and sex)

6 year female

Address

Ambah

Contact

8959756910

Referred By

Relative

Informant

Parents

Chief concerns

Speech delay

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Interaction is good

Eye contact

Suboptimal

Interaction

Wants to approach children

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Language and speech delay

Hopes from the consultation