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Republic of the Philippines
Department of Health NATIONAL NUTRITION COUNCIL
OPT Plus form 1 . List of Preschoolers with Weight and Height measurements and identified nutritional status Series 2012 Barangay: PUG-OS (DLY) Municipality : SINAIT Province: ILOCOS SUR Year : _______ Date of OPT Plus :_______________________
Date of (Yr-Mo-Day) Nutritional Status
Name of Household Age in Weight Length/ Purok Name of Preschooler Sex Weight for Length/Ht Weight for Head/Mother/Caregiver Birthday Measurement Months (kg) Height(cm) Age for Age Length/Height Weight Height/Length (1) (2) (3) (4) (5) (8) (9) (10) (11) (12) (13) (6) (7)
