Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL REGION VII

Family Profile
Zone/Sitio: ______________ City/Municipality:_____________
Barangay: _______________ Province:____________________

HH No. of No. of Children Name of HH Head Occupation Educational Check if Check if Fill in: Check if:
No. HH Attainment
Members 0-5 6- 24- >60 Mother Couple Breastfeeding ≤ 6 mos Toilet Water Food Use of IFR
mos 23 59 mos Pregnant Practice type Source Production Iodized
mos mos Family (WS, (P, W, Activity Salt
Plannin OP, S) (VG, P/L,
g O, S) FP)
EBF Mixed Bottle
Milk Feeding
Feedin
g

Abbreviations: Water Source: Toilet type Food Production Activity

EBF: Exclusive Breastfeeding P: pipe WS: water sealed VG: Vegetable Garden
HH: Household W: well OP: open sealed P/L: Poultry/Livestock
IFR: Iron Fortified Rice S: spring O: others FP: Fishpond
N: none
Abbreviations: Water Source: Toilet type Food Production Activity
EBF: Exclusive Breastfeeding P: pipe WS: water sealed VG: Vegetable Garden
HH: Household W: well OP: open sealed P/L: Poultry/Livestock
IFR: Iron Fortified Rice S: spring O: others FP: Fishpond
N: none