PatientInfo

Is child enrolled in school

Intervention plan

Consanguinity

No

Neck holding

Food preferences

HR

Neuropsychiatric condition

Place of Birth

Hospitalization

Tactile

PatientId

adfe762c-4ad7-4e53-883a-f6988295a441

FollowUpId

5b8e7519-b228-4563-9940-2198f4546826

Child's Name

Deepansh Kushwah

Age

1 Year 9 Month 18 Days

Gender

Male

DOB

2024-08-22

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Joint

Number of family members

5

Number of siblings

1

Details of siblings (Age and sex)

0

Address

Mau, bhind

Contact

8109779601

Referred By

Doctor

Informant

Parents

Chief concerns

Unable to stand, Speech delay

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Sustained

Interaction

Quality of Interaction

age-appropriate

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation