Child Registration

Child's Name:

Father's Name:

Date of Admission:

Physical Location of Admission:

Photograph Upload:

Submit

Personal History

Initial Assessment Form

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Name:

Registration No:

Gender:

Age:

Religion:

Education:

Birth Order:

Repeater:

Occupation:

Category:

Father's Name:

Father's Occupation:

Mother's Name:

Mother's Occupation:

Number of Siblings:

Siblings' Details:

Relations with Parents:

Home Address:

Contact No:

Brief History of Abuse:

Any Significant Complaint:

Work History of Child:

Remarks:

Forward to (if any):

Submit

Case History Performa

Select Child: -- Select a Child -- {% for child in children %} {{ child.child_name }} {% endfor %}

Name:

Age:

Gender:

Admission Source:

Status (Abuse/Neglect):

Parental Status:

Other Siblings in CPI:

Duration:

Family History:

Medical History:

Psychological History:

Therapeutic History:

Clinical Interview Behavior Therapy Motivational Interviewing Family Tracing Psychoeducation Cognitive Therapy Life Skill Training Rapport Building Support Therapy Formal Education

Submit

Counselling Details

Select Child: -- Select a Child -- {% for child in children %} {{ child.child_name }} {% endfor %}

Counsellor Name:

Counselling Date:

Session Notes:

Outcomes:

Submit

Individual Session

Name:

Date:

Session Details:

Submit

Group Sessions

Child 1 Name:

Child 2 Name:

Child 3 Name:

Child 4 Name:

Session Details:

Submit

Family Counselling

Family Name:

Father Name:

Mother Name:

Session Details:

Submit

Staff Counselling

Staff Role: Select Staff Role Teacher Attendant Manager Principal Others

Session Activity:

Submit

CPI Visit

Date:

Submit

CSP Visit

Date:

Submit