![SWAMI DAYANANDA KRUPA HOME - SRI PERUMBUDUR
DATE OF RECORDING THE DATA
SERIAL
NUMB
ER
IDENTIFICATION DATA AND
DEMOGRAPHIC DATA
1 NAME
2 DATE OF BIRTH
3 AGE ON RECORDING DAY OF THE DATA
4 STYLE OF COMMUNICATION :-
[ VERBAL, NON-VERBAL, GESTURAL
SINGLE WORD , FRAGMENTS ]
5 LANGUAGES SPOKEN
6 BIRTH MARKS AT LEAST TWO WHICH ARE
IDENTIFIABLE ON THE UPPER LIMBS,
EARS, NOSE, FACE.
7 AADHAR CARD
8 DISABILITY DIAGNOSIS
9 UNIQUE DISABILTY IDENTIFCATION CARD
NUMBER
10 PERMANENT ADRESS
11 FATHERS NAME
12 FATHERS AADHAR CARD NUMBER
13 MOTHERS NAME
14 MOTHERS AADHAR CARD NUMBER
15 TOTAL NUMBER OF SIBLING MALE
FEMALE
16 SIBLINGS MARITAL STATUS
17 ADRESS OF SIBLINGS
18 COMMUNICATION ADRESS
19 EMAIL OF PARENTS FATHER AND
MOTHER](https://image.slidesharecdn.com/komathicasestudy-240319125602-faafbde0/85/KOMATHI-CASE-STUDY-docx-for-social-workers-and-therapists-1-320.jpg)
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KOMATHI CASE STUDY.docx for social workers and therapists
- 1. SWAMI DAYANANDA KRUPA HOME - SRI PERUMBUDUR DATE OF RECORDING THE DATA SERIAL NUMB ER IDENTIFICATION DATA AND DEMOGRAPHIC DATA 1 NAME 2 DATE OF BIRTH 3 AGE ON RECORDING DAY OF THE DATA 4 STYLE OF COMMUNICATION :- [ VERBAL, NON-VERBAL, GESTURAL SINGLE WORD , FRAGMENTS ] 5 LANGUAGES SPOKEN 6 BIRTH MARKS AT LEAST TWO WHICH ARE IDENTIFIABLE ON THE UPPER LIMBS, EARS, NOSE, FACE. 7 AADHAR CARD 8 DISABILITY DIAGNOSIS 9 UNIQUE DISABILTY IDENTIFCATION CARD NUMBER 10 PERMANENT ADRESS 11 FATHERS NAME 12 FATHERS AADHAR CARD NUMBER 13 MOTHERS NAME 14 MOTHERS AADHAR CARD NUMBER 15 TOTAL NUMBER OF SIBLING MALE FEMALE 16 SIBLINGS MARITAL STATUS 17 ADRESS OF SIBLINGS 18 COMMUNICATION ADRESS 19 EMAIL OF PARENTS FATHER AND MOTHER
- 2. 20 EMAIL OF SIBLINGS 21 ADRESS OF LOCAL POST OFFICE 22 ADRESS OF LOCAL POLICE STATION 23 REFFERED BY 24 REASON FOR CHOOSING SWAMI DAYANANDA KRUPA HOME 25 CHIEF PRESENTING ISSUES – TO BE FILLED BY NEUROLOGIST, PSYCHIATRIST GENERAL PHYSICIAN . 26 SPECIAL EDUCATION, THERAPY HISTORY TO BE FILLED BY THE SPECIAL EDUCATOR , OCCUPATIONAL THERAPIST , PHYSIOTHERAPIST , SPEECH THERAPIST 27 BEHAVIOURAL THERAPY HISTORY TO BE FILLED BY THE CONCERNED BEHAVIOUR THERAPIST 28 ACADEMIC CERTIFICATES 10TH , 12TH, GRADUATION, NIOS FINANCIAL HISTORY 29 FATHERS BANK NAME AND ACCOUNT NUMBER 30 MOTHERS BANK NAME AND ACCOUNT NUMBER 31 RESIDENT BANK NAME AND ACCOUNT NUMBER 32 ANNUAL INCOME OF THE FAMILY 33 GOVERNMENT MONTHLY BENEFITS RECEIVED HEALTH STATUS OF PARENTS 34 THE COMPLETE HEALTH STATUS OF THE PARENTS TO BE FILLED BY A REGISTERED MEDICAL PRACTIONER RECCOMENDED BY SWAMI DAYANADA KRUPA HOME 35 HEALTH STTATUS OF THE RESIDENT TO BE FILLED BY THE REGISTERED MEDICAL PRACTIONER RECCOMENDED BY SWAMI DAYANADA KRUPA HOME[. [
- 3. DIABETES, RENAL ISSUES, SEIZURES, HYPERTENSION, , WEIGHT, SKIN ISSUES , ANY OTHER HEALTH ISSUES .] 36 GENERAL MEDICINES GIVEN WITH THE REASON 37 NEUROLOGICAL MEDICINES GIVEN WITH THE REASONS 38 PSYCHIATRIC MEDICINES GIVEN WITH THE REASON 39 AYURVEDHA , SIDDHA, UNNANI, HOMEPATHY MEDICINE GIVEN WITH THE REASON 40 THERAPIES TO BE GIVEN 41 DIETARY NEEDS [ CASEIN, GLUTIN ] 42 SENSORY NEEDS [ TO BE FILLED BY OCCUPATIONAL THERAPIST WHO HOLDS A CERTIFCATION IN SENSORY INTEGRATION] 43 PRENATAL – NATAL –POST NATAL HISTORY TO BE FILLED BY GENERAL PHYSICIAN 44 DEVELOPMENTAL HISTORY TO BE FILLED BY SPECIAL EDUCATOR/PHYSIOTHERAPIST 45 SPEECH LANAGUAGE AND COMMUNICATION HISTORY TO BE FILLED BY SPEECH PATHOLOGIST 46 MOTOR DEVELOPMENT TO BE FILLED BY PHYSIIOTHERAPIST 47 VISUAL EVALUATION TO BE FILLED BY OPTHALOMOLOGIST 48 HEARING EVALUATION BY ENT 48 BEHAVIOUR ;- EVALUATION BY PSYCHIATRSIT/ CLINICAL PSYCHOLOGIST 49 LEISURE TIME ACTIVITIES 50 FUNCTIONAL ACADEMIC ABILITIES TO BE EVALUATED BY SPECIAL EDUCATOR 51 INTELLIGENT QUIOTENT BY CLINICAL
- 4. : PSYCHOLOGIST 52 ASSOCIATED DISABILITES TO BE FILLED BY GENERAL PHYSICIAN, NEUROLOGIST, PSYCHIATRIST. 53 STRENGTH AND WEAKNESS OF THE RESIDENT 54 VOCAITONAL EVALUATION BY VOCATIONAL TRAINER 55 SOCIAL /EMOTIONAL SKILL EVALUATION BY PSYCHOLOGSIT 56 HOBBIES 57 SPECIFC TALENTS 58 PARENTAL REQUIREMENTS 59 LEGAL GUARDIAN 60 LOCAL GUARDIAN 61 PERSON WHO ELSE CAN BE CONTACTED IN CASE OF EMERGENCY.