_______________________ ELEMENTARY SCHOOL

_______ District
NUTRITIONAL STATUS REPORT
School: Teacher:
Grade: Date:
Deped Memo No. 165, s 2010
Date
Boys # Names Taken Birthday Age Weight(kg) Height(cm) BMI REMARKS
1 Abdul, Paris A. 07-4-16 03-24-05
2 Abdula, Movin S. 07-4-16 07-07-21
3 Alpad, Michael S. 07-4-16 10-08-04
4 Amora, Samuel P. 07-4-16 10-12-03
5 Ayunan, Kenneth G. 07-4-16 05-24-04
6 Biantan, Jaymar O. 07-4-16 07-29-06
7 Bontanon, John Paul 07-4-16 11-08-05
8 Calonia, Michael John B. 07-4-16 01-30-06
9 Diga, Benzar A. 07-4-16 07-18-06
10 Delito, Christian P. 07-4-16 12-19-05
11 Entia, Mark C. 07-4-16 11-11-05
12 Fabale, Ehman Miguel S. 07-4-16 12-31-05
13 Figuracion, Arjay P. 07-4-16 12-15-04
14 Genodepanon, Reydan D. 07-4-16 04-23-01
15 Gumba, Vincent C. 07-4-16 07-20-04
16 Magtulis, Wisley G. 07-4-16 03-24-06
17 Parreno, Waren A. 07-4-16 05-26-06
18 Pasandalan, Rheanie Jane C. 07-4-16 03-16-06
19 Rellin, Ricson D. 07-4-16 02-04-06
20 Rojas, Rey Glenn C. 07-4-16 12-29-00
21 Rosit, Nathaniel S. 07-4-16 12-10-02
22 Setenta, Oliver S. 07-4-16 07-30-05
23 Siloy, Eric James B. 07-4-16 04-13-06
24 Talib, Abdul A. 07-4-16 11-15-03
25 Villaroel 07-4-16

Girls Date
# Names Taken Birthday Age Weight(kg) Height(cm) BMI REMARKS
1 Andre-e, Cristine B 07-4-16 04-09-06
2 Albiso, Princess Dianne B. 07-4-16 03-29-06
3 Alumbro, Rolyn B. 07-4-16 06-13-06
4 Amar, Evelyn B. 07-4-16 06-28-06
5 Boston, Lie May H. 07-4-16 12-10-04
6 Endar, Jeralyn O. 07-4-16 01-19-06
7 Evidientes, Donna Marie M. 07-4-16 04-10-05
8 Limbuna, Nawiah S. 07-4-16 01-16-03
9 Malaque, Juliana P. 07-4-16 01-09-06
10 Mamalimping, Aisa A. 07-4-16 09-03-04
11 Pallada, Kaye T. 07-4-16 11-30-06
12 Pilapil, Michaella P. 07-4-16 01-04-06
13 Ricamora, Jovy Laiza P. 07-4-16 09-12-05
14 Tagalog, Rachel B. 07-4-16 10-12-10
15 Tagle, Zel Jane C. 07-4-16 12-29-05
16 Tejano, Janessa A. 07-4-16 10-19-06
17 Trago 07-4-16
18 Whittmer, Nicole T. 07-4-16 06-08-06
 Region XII
Division of _____________
_____________________ District

NUTRITIONAL STATUS SUMMARY REPORT

School: ______________________________ ELEMENTARY SCHOOL

Teacher:
Grade:
Date: 07/07/2016

Table A. Tabulated Data Presentation

Boys Girls Total

Nutrition Result Total Percent Total Percent Total Percent
Severely Wasted:
Wasted:
Normal:
Overweight:
Obese:
Grand Total

Table B. Graphical Data Presentation

Nutrition Status Percentage

Severely Wasted:
Wasted:
Normal:
Overweight:
Obese:
CREATED BY: DOMINICK L. DERILO