PatientInfo

Is child enrolled in school

Yes

Intervention plan

Parents counselled

Consanguinity

No

Neck holding

Achieved

Food preferences

Picky eater

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

0a6cdf1e-40ed-4dca-b708-4ee91109c2ac

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Udbhav Pathak

Age

4 Year 4 Month 11 Days

Gender

Male

DOB

2021-10-28

Mother’s age (years)

39 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

43 years

Father’s education

Father’s occupation

Real estate

Type of family

Joint

Number of family members

5

Number of siblings

0

Details of siblings (Age and sex)

Address

Contact

8109739947

Referred By

Doctor

Informant

Parents

Chief concerns

Speech delay

Duration of symptoms

Speech therapy 20 sessions attended

Concerns noticed by school (if any)

Strengths of child

Eye contact

Fleeting

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation