PatientInfo

Is child enrolled in school

No

Intervention plan

IDP 2/week + PMT 15/days

Consanguinity

Neck holding

Food preferences

Mixed

HR

Neuropsychiatric condition

Place of Birth

Hospitalization

Tactile

PatientId

3cf73fb5-fc61-46bf-bce9-9e70038ef86c

FollowUpId

193bc610-82e4-4204-836a-30d745e9007b

Child's Name

Swastik Sharma

Age

5 Year 8 Month 15 Days

Gender

Male

DOB

2020-06-12

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Number of family members

Number of siblings

Details of siblings (Age and sex)

Address

Contact

9575111122

Referred By

Informant

Chief concerns

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Suboptimal

Interaction

Deliberately ignores

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Following command- better

Impression

Hopes from the consultation