PART - B

NUTRITIONAL STATUS

Weights of Pre-School Children (Source: ) VADAG Cases (Source: )

Normal Underweight Overweight Total Night Diarrhea Cases R

Weighed Blindness Anemia Goiter a
PUROK (Source: )
(9) (10) (11) (12) n
(Name of Number) k
i
Underweight Severely PS SC SC P/L SC 15 PS SC P/L 15 n
Underweight years years g
and and
over over

(1) (2) (3) (4) (5) (7) (a) (b) (a) (b) (a) (b) (a) (b) © (d) (13)
TOTAL / PERCENT
 FORMAT B
HEALTH AND NUTRITION SITUATION OF OTHER RELEVANT INFORMATION

Name of Barangay:

PART A

I. GENERAL INFORMATION II. PRESCHOOL (PS) AND SCHOOL CHILDREN (SC) PS SC

(1) Total No. of Puroks: (1) Total No. of Surveyed / Enrolled:

(2) Total Population: (2) Total No. Weighed:
(3) Total No. of Households: (3) % Weighed:
(4) Total No. Of Infants (0-11 months): (4) Total No. With Normal Weights:
(5) Total No. of Pregnant Women: (5) Total No. with Underweight/Wasted
(6) Total No. of Lactating Women: (6) Total No. with Overweight:
(7) No. of Households with Home Gardens: (7) Total No. of Children with
(8) Total No. of Households with Cleft Palate/Harelip:
Sanitary Toilet: (8) Total No. of Households with
(9) Total No. of Households with Underweight/Wasted Children:
Potable Water Supply: (9) Prevalence Rate of Children
(10) Most Common Occupation: Underweight/Wasted: