PatientInfo

Is child enrolled in school

No

Intervention plan

IDP 2/week + PMT 1/week

Consanguinity

No

Neck holding

Achieved

Food preferences

Picky eater

HR

Neuropsychiatric condition

No

Place of Birth

Institutional

Hospitalization

No

Tactile

Hyposensitive

PatientId

b09a723b-6a4b-4628-be95-47cda1072f55

FollowUpId

00000000-0000-0000-0000-000000000000

Child's Name

Lakshay

Age

3 Year 3 Month 30 Days

Gender

Male

DOB

2023-02-24

Mother’s age (years)

28 years

Mother’s education

Mother’s occupation

Homemaker

Father’s age (years)

35 years

Father’s education

Father’s occupation

Private job

Type of family

Joint

Number of family members

Number of siblings

Details of siblings (Age and sex)

Address

Contact

7879020372

Referred By

Doctor

Informant

Parents

Chief concerns

Delayed speech, Hyperactivity

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

Handflapping, stimming

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

? ASD

Hopes from the consultation