PatientInfo

Is child enrolled in school

Yes

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

842dffce-5779-4a87-b9dc-c9b7a527cf10

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Vedant Katare

Age

5 Year 6 Month 9 Days

Gender

Male

DOB

2020-09-28

Mother’s age (years)

35 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

36 years

Father’s education

Father’s occupation

Into construction

Type of family

Joint

Number of family members

12

Number of siblings

1

Details of siblings (Age and sex)

1- 1year old female

Address

Morar

Contact

9893427605

Referred By

Doctor

Informant

Parents

Chief concerns

Behaviorqal issues

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