Name of Child: Alisha Sayyed
Father’s Name: Jafar Mother’s Name : Ashifa
Address: Shastri nagar, no. 3 Bandra west Mumbai
Age: 6 years Date of Birth: 26/07/ Sex: [ ] Male [F] Female
Mobile No: (1)7498726035 (2) 9321305399
No Of Sibling: Brother: 1 Sister: –
Total Family Member’s: (Including Grand father, Grand mother, Uncle, Aunty): 6
Monthly Family Income: 12,000/-
House: [ ] Owner Ship [ ] Rent ____ Maintenance per Month: Rs.__________
Child Diagnosis: Post traumatic read GDD with epilepsy
Child History: Full term baby c normal delivery milestones delay. Had a fall followed by epileptic attack at the age of 9 months and she was unconscious admitted in ICU for 1 month then diagnosed c brain TB. Treatment was done.
Current Therapies: Physio therapy, Occupational therapy and Art based therapy.