PatientInfo

Is child enrolled in school

Yes

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Picky eating

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

6f7d96e1-2034-44fe-9f13-03da35653d63

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Dishant Sharma

Age

6 Year 2 Month 23 Days

Gender

Male

DOB

2020-01-02

Mother’s age (years)

30 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

35 years

Father’s education

Father’s occupation

Private job (Aditya Birla)

Type of family

Joint

Number of family members

6

Number of siblings

1

Details of siblings (Age and sex)

11 year old

Address

Contact

8959461248

Referred By

Doctor

Informant

Parents

Chief concerns

Speech delay, behavioral concerns

Duration of symptoms

Hyperactivity since early infancy

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