GETTING TO KNOW YOUR CHILD Child Name Date of Birth (DOB) Age Sex MaleFemaleOther Date of Admission (D.O.A) Referred By Mother's Name Mother's Occupation Father's Name Father's Occupation Guardian Name Contact Number Address Chief Complaint Speech NoNot ProperProper Language NoNot ProperProper Head Control PoorPartialAchieved Sitting PartialAchieved Standing UnstableStable Walking SupportedUnsupported H/o Seizure YesNo EEG Finding NormalAbnormal MRI Brain Δ
