Street Pantay Pantay Pantay Pantay Pantay Pantay Pantay Pantay Pantay Pantay Pantay Pantay Pantay Pantay

Bituin Bituin Bituin Bituin Bituin Bituin Bituin Bituin Bituin Bituin Bituin Bituin Bituin Bituin

Purok I I I I I I

Household Name of Household Head/ Number Mother/ Caregiver Dasadre, Emmanuel De Leon, Kevin Gatus, Jeffrey Mendoza, Rolando Leroux, Polery Gatus, Jeffrey

Kate Raziel Khylie Myuki

Name of Preschooler Christian Dale King Jacob Jaden Jerald Princess Assiah Gwekhalyn Jenina Marie Carina mae Jerimiah Jerome Rhea angeline Azel john Vlanier Vincent Sophia Josh Kate Raziel Khylie Myuki

Sex B B B G G G G B B G B B B G B G G

Birthday 09/03/2007 12/12/2012 06/25/2011 03/08/2010 06/23/2012 09/12/2012 04/14/2008 09/01/2012 06/03/2007 01/28/2011 04/27/2011 09/06/2008 02/28/2010 03/09/2009 12/26/2009 08/16/2012 07/22/2012

Date of Age in Weight Length/ Measurement Month (kg) Height 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 02/07/2013 01/05/1900 02/07/2013
65 1

19
34 7

4
57 5 68 24 21 53 35 46 37 5 6

18.2 9.6 12.0 11.9 9.0 6.3 16.4 7.8 18.1 10.8 10.7 17.7 13.9 16.6 19.0 8.5

106.0 73.0 82.0 86.0 65.0 60.0 102.0 66.5 109.0 81.0 76.0 106.0 94.0 96.5 100.0 65.0

WFA L/HFA WFL/H N OW

N

N T
N

N N
N

N N
N

S N
N

N OW
N

N N N N N N N N N SS N N N N N N OW N N N

N N N N N N N N OW N

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Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Purok (1) Household Number (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Month Weight Height/L (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Purok (1) Household Number (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of Preschoolers with Weight and Height Measurement and Identified Nutritional Status
Revised February 2012

Barangay: Paliwas Household Purok Number (1) (2)

Municipality: Obando Name of Household Head/ Mother/ Caregiver (3)

Province: Bulacan Name of Preschooler (4) Sex (5)

Year: 2013 Birthday (6)

Date of OPT Plus: Date of Age in Height/L Month Weight ength (7) (8) (9)

*Codes for nutritional status:

Weight-for-Age: N- Normal UW- Underweight SUW-Severly Underweight OW- Overweight Length/Height-for-Age: N- Normal St- Stunting SSt- Severely Stunting T- Tall Weight-for-Length/Height: N- Normal W- Wasted SW-Severly Wasted OW- Overweight Ob- Obese 1/nAge-in-monthsn refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. Prepared by: Date: Raymundo, Rebecca Libiran Name and Signature of Barangay Nutrition Scholar Checked: Date:

Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Date:

Date:

of OPT Plus: Weight Length/ Nutritional Status* (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

of OPT Plus: Nutritional Status* Weight Length/ (kg) Height WFA L/HFA WFL/H (10) (11) (12) (13) (14)

t/City Nutrition Program Coordinator

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Province: Bulacan Weighing Period and Year:

Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2)

Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran

Date:

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL

LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B)

Barangay: Paliwas Municipality: Obando Nutritional Status:

Household Number (1) Name of Household Head/ Mother/ Caregiver (2)

Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number Name of Household Head/ Mother/ Caregiver Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed

Sex

(1)

(2)

(3)

(4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines

Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B)

Barangay: Paliwas Municipality: Obando Nutritional Status:

Household Number (1) Name of Household Head/ Mother/ Caregiver (2)

Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL LIST OF PRIORITY PRESCHOOLERS 0-71 MONTHS OLD (OPT FORM 1B) Barangay: Paliwas Municipality: Obando Nutritional Status: Household Number (1) Name of Household Head/ Mother/ Caregiver (2) Province: Bulacan Weighing Period and Year:

Name of Preschooler Weighed (3)

Sex (4)

Prepared by: Raymundo, Rebecca Libiran Validate/Noted by: Submitted to:

Date: Date: Date:

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month

(5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Age in Month (5)

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

Republic of the Philippines Department of Health NATIONAL NUTRITION COUNCIL OPT Plus Form 1. List of 0-71 Months Affected or at Risk Preschoolers
Revised February 2012

Barangay: Paliwas City/Municipality: Obando Instruction:

In column 1, copy the household number from the family profile In column 2, write the family name first, followed by name of the household head In column 3, write the first name of the preschool child In column 4, write "B" for boy and "G" for the girl In column 6, indicate the age in month based on the last completed month In column 7-14, check the appropriate nutritional status For the TOTAL row, add all the values in each column

In column 5, specify if household member belongs to an indigenous people group, write "NA" if not a

Household Number (1)

Name of Household Head/ Mother/ Caregiver (2)

Name of Preschooler Weighed (3)

Sex Indigenous Group (4) (5)

Age in Month (6)

Nutritional Sta UW SUW St

Prepared by:

Raymundo, Rebecca Libiran____ __ Name and Signature of Barangay Nutrition Scholar

Checked by: Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Date:

Approved by: Name and Signature of Baran BNC Chairperson Date:

Date:

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson

us people group, write "NA" if not applicable

Nutritional Status SSt W SW

OW

Ob

. ame and Signature of Barangay Captain BNC Chairperson