PatientInfo

Is child enrolled in school

No

Intervention plan

Home strategies adviced

Consanguinity

No

Neck holding

Achieved

Food preferences

Mixed

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

Yes

Tactile

PatientId

ec666af8-758c-480d-b68c-b145b645003b

FollowUpId

26972dee-3ef4-4609-be32-a4d7ab186dd2

Child's Name

Roopchand Rajpoot

Age

4 Year 10 Month 0 Days

Gender

Male

DOB

2021-09-18

Mother’s age (years)

23 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

35 years

Father’s education

Father’s occupation

Farmer

Type of family

Joint

Number of family members

6

Number of siblings

1

Details of siblings (Age and sex)

8 year old female

Address

Mahoba

Contact

9219536981

Referred By

Doctor

Informant

Parents

Chief concerns

Duration of symptoms

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