FOLLOW UP FORMAT

Format for giving information or follow up of your kid across whatsapp 

Name of child

Date of birth

City

Payment date and time and mode

LAST CONSULTATION DATE:

TODAYS DATE:

See weekly symptom monitoring diary at http://bit.ly/monitoringautism

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WRITE YES , NO, BETTER OR WORSE  BY HOW MANY PERCENT APPROXIMATE, ORT 0 TO 5, 5 IS BEST

List changes as per-- Comparing now with two week back.. and send me pl, BY WHATSAPP TO 9869405747

1. Eye to eye connection--

2.Concentration-

3-Obeying commands-

4.Response to sounds -

5. Unnecessary Jumping or running -

6.Biting mouthing throwing hitting hurting :

7.Sleep-

8.Constipation-

9.pointing, gripping, imitation, Writing -

10.Sounds from mouth-

11.Speech-

12. Pretend play, role play, Comprehension and stories listening skills, sequential

13. Other (sensory issues/ school issues/behaviours)-

14. Mixing with peers in sitting games, group work

List as gains and goals, rather than writing positives or negatives

List any medicine doses changed recently.

List any medicine couldn't be taken with number of days couldn't be taken. Read more at www.autismmumbai.com.  payments to 9869405747 only

ALSO SPECIFY ANY OR MANY FO THE ISSUES BELOW:

15. Does your child Keep on walking/running? Jumping/climbing? 

16. Hitting / hurting? Rolls on floor? 

17. Cries all the day? Shouts /screams? 

18. Potty is hard/ NOT daily?

 19. Scared/ feared? 

20. Puts hand on ear or angle vision? 

21. Stubborn for gains? Or.Wanting something?

22.Scared? Anxiety? Constipation? Which one is maximum? 

23. often in a day these issues happening? 

These details will help me plan medicine titration