Scribd
Upload
2K views2 pages

OPT Plus Masterlist Form - Updated - Feb 2021

This document contains forms for recording nutritional screening data of preschool children ages 0-59 months. Form 1 lists identifying information for each child such as name, age, and measurements for weight, length/height, and mid-upper arm circumference (MUAC). It also records the child's identified nutritional status. Form 1B specifically lists malnourished or nutritionally at-risk children and their nutritional status according to weight-for-age, length/height-for-age, weight-for-length/height, and MUAC. The forms require signatures from nutrition workers to verify the data was collected and reviewed properly.

Uploaded by

Jolland Palomares Sumalinog
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
2K views2 pages

OPT Plus Masterlist Form - Updated - Feb 2021

This document contains forms for recording nutritional screening data of preschool children ages 0-59 months. Form 1 lists identifying information for each child such as name, age, and measurements for weight, length/height, and mid-upper arm circumference (MUAC). It also records the child's identified nutritional status. Form 1B specifically lists malnourished or nutritionally at-risk children and their nutritional status according to weight-for-age, length/height-for-age, weight-for-length/height, and MUAC. The forms require signatures from nutrition workers to verify the data was collected and reviewed properly.

Uploaded by

Jolland Palomares Sumalinog
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
You are on page 1/ 2

Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL

OPT Plus Form 1. List of 0-59 months old Preschoolers with Weight, Length/Height and MUAC Measurements, and Identified Nutritional Status
Revised February 2021
Barangay: __________________________________ City/Municipality: ____________________________ Province: ___________________________________ Region: _____ Year: _________

Date of Date of Age in Measurement Bilateral Nutritional Status*


Seq. Household Name of Mother Name of Preschooler IP 4Ps Sex Pitting
Current Purok Birth Measurement Months Weight Length/ MUAC Edema MUAC Weight for Length/Height Weight for
OPT Number (Surname, First Name & Middle Initial) (Surname, First Name & Middle Initial) Height
(Y/N) (Y/N) (M/F) (MM/DD/YYYY) (MM/DD/YYYY) (kg) (cm) (Y/N) Status Age for Age Length/Height

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19)

(11)/"Age-in-months" refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. If the child is day/s old or less than 1 month old, put 0.

Note: Use WEIGHT-FOR-LENGTH for 0-23months old preschool children and WEIGHT-FOR-HEIGHT for 24-59 months old preschool children
Use WEIGHT-FOR-LENGTH or WEIGHT-FOR-HEIGHT to correctly determine overweight and obesity.

Prepared by: Checked & Verified: Attested: Noted:

___________________________________________ ___________________________________________ _________________________________________ _____________________________________________


Name and Signature of Barangay Nutrition Scholar Name and Signature of Public Health Midwife Name and Signature of BNC/Barangay Chairman Name and Signature of City/Municipal Nutrition Action Officer
Date: _____________________ Date: _____________________ Date: _____________________ Date: _____________________
Republic of the Philippines
Department of Health
NATIONAL NUTRITION COUNCIL

OPT Plus Form 1B. List of Malnourished/Nutritionally-At-Risk Preschoolers 0-59 Months Old
Revised February 2021

Barangay: _____________________________________ Province: _______________________________ Period of Measurement Covered :


City/Municipality: ______________________________ Region: _______ ___________________________________

NUTRITIONAL STATUS
Seq. Household Name of Mother Name of Preschooler Sex Indigenous (IP)/ Age in
Purok WFA L/HFA WFL/H MUAC Status
No. Number (Surname, First Name & Middle Initial) (Surname, First Name & Middle Initial) (M/F) Ethnic Group months
UW SUW St SSt W SW OW Ob SAM MAM Edema
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19)

TOTAL

Prepared by: Checked and Verified: Attested: Noted:

_____________________________________________________ __________________________________________________ ________________________________________ ___________________________________________


Name and Signature of Barangay Nutrition Scholar Name and Signature of Public Health Midwife Name and Signature of BNC/Barangay Chairman Name & Signature of City/Mun. Nutrition Action Officer
Date: _____________________ Date: _____________________ Date: _____________________ Date: _____________________

You might also like