Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL

OPT Plus Form 1. List of preschoolers with weight and heigh measurement and Nutritional Status
Barangay: S. OSMEA City/ Municipality: GOV. GENEROSO Province: DAVAO ORIENTAL Year: 2017 Date of OPT Plus:

Purok Househol Name of Household Name of Sex Date if (Yr-Mo-Day) Age in Weight Length/heig
(1) d Head/Mother/Caregiver Preschooler (5) Months (kg) ht
Number (3) (4) Birthday Measurement (9) (10) (cm) Weight for Length/height Weight for
(2) (6) (11) Age for age Length/Height
Weight Length/h
(12) (13) (14)
(7) eight
(8)

Codes for nutritional status: Weight-for-Age: N-Normal UW-Underweight SUW-Severely Underweight OW-Overweight Note/Use WEIGHT FOR-LENGTH for-0-23 months old preschool
Children and
Length/Height for age: N-Normal St- Stunting SST-Severely Stunting T-Tall WEIGHT-FOR-HEIGHT for 24-60 months old preschool child
Weight-for Height/Length: N-Normal W-Waster SW-Severely Wasted OW-Overweight Ob-Obese Use Weight-for Length or weight for-height to correctly
Age-in-months refers to completed number of
Months for instance 34 months and 30 days is considered 34 months only

Prepared by: BEVERLY ANUNCIO Checked: MARIEVIC D. PINTO

Name and Signature Barangay Nutrition Scholar Name and Signature of Midwife/Nurse/District/City/Nutrition of Program Coordinator

Date: Date:

Should be placed at Barangay Hall