PatientInfo

Is child enrolled in school

Yes

Intervention plan

IDP 2/ week

Consanguinity

No

Neck holding

Achieved

Food preferences

HR

94/min

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

PatientId

e899ea97-9ce1-4cb5-a22f-0430196a309d

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Amit jatab

Age

13 Year 6 Month 7 Days

Gender

Male

DOB

2012-08-05

Mother’s age (years)

32 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

34 years

Father’s education

Father’s occupation

Private job

Type of family

Joint

Number of family members

Number of siblings

1

Details of siblings (Age and sex)

11 year old male

Address

Bawripur

Contact

9372053449

Referred By

Doctor

Informant

Grandfather, father

Chief concerns

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Sustained

Interaction

Quality of Interaction

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation