PatientInfo

Is child enrolled in school

Yes

Intervention plan

Parents counselled.

Consanguinity

No

Neck holding

Achieved

Food preferences

Picky eating

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

907b9083-4b56-4a88-b2c2-4dd3e90c5aae

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Rashi Pal

Age

7 Year 8 Month 28 Days

Gender

Female

DOB

2018-05-19

Mother’s age (years)

23

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

24

Father’s education

Father’s occupation

Works in Nagpur

Type of family

Joint

Number of family members

Number of siblings

2

Details of siblings (Age and sex)

1- 5 year old female, 2- 2 year old male

Address

Lalitpur

Contact

9076966705

Referred By

Doctor

Informant

Grandparents

Chief concerns

Poor understanding, speech delay

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Fleeting

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Intellectual Disability. Epilepsy.

Hopes from the consultation