PatientInfo

Is child enrolled in school

Intervention plan

Consanguinity

No

Neck holding

Food preferences

HR

Neuropsychiatric condition

Place of Birth

Institutional

Hospitalization

Tactile

Hyposensitive

PatientId

fb04ed30-11ff-424d-b49b-247a3860095f

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Ankush Rajavat

Age

4 Year 9 Month 19 Days

Gender

Male

DOB

2021-07-15

Mother’s age (years)

Mother’s education

Mother’s occupation

Teacher

Father’s age (years)

Father’s education

Father’s occupation

Govt service

Type of family

Nuclear

Number of family members

2

Number of siblings

1

Details of siblings (Age and sex)

12 year old female

Address

Contact

8889626917

Referred By

Doctor

Informant

Mother, maternal uncle

Chief concerns

Hyperactivity, poor response to name call, poor interaction

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Poor

Interaction

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation