PatientInfo

Is child enrolled in school

Intervention plan

Consanguinity

Neck holding

Food preferences

HR

Neuropsychiatric condition

Place of Birth

Hospitalization

Tactile

PatientId

7e547fef-ee0a-4b98-8000-71a75cf27853

FollowUpId

5cb01e43-9f67-4046-93c4-916e3b03e9e1

Child's Name

dsds

Age

12

Gender

fdfd

DOB

2010-05-01

Mother’s age (years)

2

Mother’s education

232

Mother’s occupation

23

Father’s age (years)

232

Father’s education

232

Father’s occupation

232

Type of family

2

Number of family members

23

Number of siblings

23

Details of siblings (Age and sex)

232

Address

232

Contact

23232

Referred By

232323

Informant

2323

Chief concerns

2323

Duration of symptoms

2323

Concerns noticed by school (if any)

2323

Strengths of child

23232

Eye contact

23232

Interaction

2323

Quality of Interaction

3

Repetitive behaviors (RRBs)

If yes- Details

ere

Patterned behavior or activities

If yes- Details

2323

Others

Details:

dfdf

Impression

23df

Hopes from the consultation

ere