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OPT Plus Form 1. List of Preschoolers With Weight and Height Measurement and Identified Nutritional Status
OPT Plus Form 1. List of Preschoolers With Weight and Height Measurement and Identified Nutritional Status
List of preschoolers with weight and height measurement and identified Nutritional Status
Philippine Plan of Action for Nutrition
Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday
Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday
Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday
Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday
Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday
Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday
Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday
Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday
* Codes for nutritional status: Weight-for-age: N- Normal; UW-Underweight; SUW-Severely 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-Severely Wasted; OW-Overweight; Ob-Obese
1/
"Age in months" refers to completed number of months. For instance, 34 months and 27 days is considered 34 months only
Prepared by:
Name and Signature of Barangay Nutrition Scholar
Date:
ce: _________________ Year: _________ Date of OPT Plus: _____________
Checked:
Name and Signature of Midwife/ Nurse/ District/ City
Nutrition Program Coordinator
Date: