PatientInfo

Is child enrolled in school

Yes

Intervention plan

Consanguinity

No

Neck holding

Achieved

Food preferences

Picky eater

HR

Neuropsychiatric condition

Yes

Place of Birth

Institutional

Hospitalization

Yes

Tactile

Hypersensitive

PatientId

c6aab76d-accf-4cb3-aee8-89cfdc3f9a9f

FollowUpId

bebdb42e-1138-4b03-bcd6-f5e1547978d2

Child's Name

Vaishnavi

Age

8 Year 5 Month 21 Days

Gender

Female

DOB

2017-10-20

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

9582063905

Referred By

Doctor

Informant

Parents

Chief concerns

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Poor

Interaction

Quality of Interaction

limited

Repetitive behaviors (RRBs)

If yes- Details

Earlier was looking at lateral angle of eyes

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation