PatientInfo

Is child enrolled in school

No

Intervention plan

IDP 1/week, PMT 1/mon

Consanguinity

No

Neck holding

Achieved

Food preferences

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

d1e40fbc-58ec-44a4-aef0-d69277a433ba

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Sangeeta Jatav

Age

4 Year

Gender

Female

DOB

2022-02-04

Mother’s age (years)

20 years

Mother’s education

Mother’s occupation

Housewife

Father’s age (years)

23 years

Father’s education

Father’s occupation

Pvt job

Type of family

Joint

Number of family members

15

Number of siblings

1

Details of siblings (Age and sex)

Address

Ghas mandi

Contact

7970130188

Referred By

Doctor

Informant

Parents

Chief concerns

Poor understanding, Speech delay

Duration of symptoms

Since birth

Concerns noticed by school (if any)

Strengths of child

Eye contact

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation