QUARTERLY MONITORING OF NUTRITIONAL STATUS (0-59 months)

Barangay: _________________________________ Accomplished by: ___________________________________ Checked/Noted by: _______________________________

Address or NUTRITIONAL STATUS

Location Name of Mother Belongs
Full Name of Child to IP Sex Date of Birth Date Measured Age in Weight Height
No. of Child's or Caregiver Group? REMARKS
MM/DD/YYYY MM/DD/YYYY Months
Residence WFA HFA WFH/L
YES/NO M/F (kg) (cm)

TOTAL NO. OF CHILDREN WEIGHED: No. of UW: No. of SUW: Approved by:
Male = No. of St: No. of SSt: No. of T: _____________________________________________
Female = No. of W: No. of SW: No. of OW: No. of Ob:
Legend: UW - Underweight; SUW - Severely Underweight; St - Stunted; SSt - Severely Stunted; T - Tall; W - Wasted; SW - Severely Wasted; OW - Overweight; Ob - Obese
 Address or NUTRITIONAL STATUS
Location Name of Mother Belongs
Full Name of Child to IP Sex Date of Birth Date Measured Age in Weight Height
No. of Child's or Caregiver Group? REMARKS
MM/DD/YYYY MM/DD/YYYY Months
Residence WFA HFA WFH/L
YES/NO M/F (kg) (cm)