1. Name of the client

2. Phone Number

3. Date of birth  of the client

4. Birth cry

5. Birth Weight 

6. Intubated after jaundice no of days /  पीलिया के बाद कित्ने दिन इनुबते किये 

7. Place of Delivery
8. Type of Delivery

9. Neck control/ गर्दन कब ठहरी/ गर्दन पर नियंत्रण कब आया no of months

10. Rollover /  लुढ़कना / उलटना no of months

11. Crawling no of months/  रिंगण  at what age 

12. Sitting  w/o support/ बैठना/ no of months

13. standing  w/o support/बिना सहारे के खड़ा होना  at what age 

14. Speech developed / बोलना  at what age in months 

15. No of words produced/बच्चा कितने शब्द बोलता/बोलती है at what age   

16. Climbing up stairs at the age of in months


19. No of fits/ epelepsy /बच्चे को कित्ने बार मिर्गी/ की संख्या  at what age it started

20. Chief complaints why child was brought to clinic