Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL

OPT Plus Form 1 List of preschoolers with height measurement and identified Nutritional Status

Barangay: PINDOLONAN Municipality: SAGUIARAN Province: LANAO DEL SUR Year:2022 Date of OPT Plus: March , 2022

Househol Name of Household Head Name of Preschooler Sex Date of Birth Age in Weight Length Nutritional Status
d Mother/Caregiver (Yr-Mo-Day) Month (kg) Height
Number Birthday Measurement s (cm) Weight Length/ Weight for
for Ht for Length/
Age Age Height

 Codes For nutritional Status Weight For Age N-Normal UW-Underweight SUW-Severely Underweight OW-Overweight
Length/Height for Age N-Normal St-Stunting SST-Severely Stunting T-Tall
Weight for Length/Height N-Normal W-Wasted SW-Severely Wasted OW-Overweight OB-Obese
“Age in months” always refers to completed number of months i.e. 34 month and 30 days is considered 34 months only

Prepared by Checked by
Name & Signature of Barangay Nutrition Scholar Name & signature of Midwife

Date Date
 Republic of the Philippines
Department of Health
National Nutrition Council

OPT Plus Form 1 List of preschoolers with height measurement and identified Nutritional Status

Barangay: PINDOLONAN Municipality: SAGUIARAN Province : LANAO DEL SUR Year: 2022 Date of OPT Plus: March , 2022

Househol Name of Household Head Name of Preschooler Sex Date of Birth Age in Weight Length Nutritional Status
d Mother/Caregiver (Yr-Mo-Day) Month (kg) Height
Number Birthday Measurement s (cm) Weight Length/ Weight for
for Ht for Length/
Age Age Height

 Codes For nutritional Status Weight For Age N-Normal UW-Underweight SUW-Severely Underweight OW-Overweight
Length/Height for Age N-Normal St-Stunting SST-Severely Stunting T-Tall
Weight for Length/Height N-Normal W-Wasted SW-Severely Wasted OW-Overweight OB-Obese
“Age in months” always refers to completed number of months i.e. 34 month and 30 days is considered 34 months only

Prepared by Checked by
Name & Signature of Barangay Nutrition Scholar Name & signature of Midwife
 Date Date

OPT Plus Form 1 List of preschoolers with height measurement and identified Nutritional Status

Barangay Municipality: LAL-LO Province : CAGAYAN Year: Date of OPT Plus:

Househol Name of Household Head Name of Preschooler Sex Date of Birth Age in Weight Length Nutritional Status
d Mother/Caregiver (Yr-Mo-Day) Month (kg) Height
Number Birthday Measurement s (cm) Weight Length/ Weight for
for Ht for Length/
Age Age Height

 Codes For nutritional Status Weight For Age N-Normal UW-Underweight SUW-Severely Underweight OW-Overweight
Length/Height for Age N-Normal St-Stunting SST-Severely Stunting T-Tall
Weight for Length/Height N-Normal W-Wasted SW-Severely Wasted OW-Overweight OB-Obese
“Age in months” always refers to completed number of months i.e. 34 month and 30 days is considered 34 months only
 Prepared by Checked by
Name & Signature of Barangay Nutrition Scholar Name & signature of Midwife

Date Date

OPT Plus Form 1 List of preschoolers with height measurement and identified Nutritional Status

Barangay: PINDOLONAN Municipality: SAGUIARAN Province: LANAO DEL SUR Year: 2022 Date of OPT Plus: March , 2022

Househol Name of Household Head Name of Preschooler Sex Date of Birth Age in Weight Length Nutritional Status
d Mother/Caregiver (Yr-Mo-Day) Month (kg) Height
Number Birthday Measurement s (cm) Weight Length/ Weight for
for Ht for Length/
Age Age Height

 Codes For nutritional Status Weight For Age N-Normal UW-Underweight SUW-Severely Underweight OW-Overweight
Length/Height for Age N-Normal St-Stunting SST-Severely Stunting T-Tall
Weight for Length/Height N-Normal W-Wasted SW-Severely Wasted OW-Overweight OB-Obese
 “Age in months” always refers to completed number of months i.e. 34 month and 30 days is considered 34 months only

Prepared by Checked by
Name & Signature of Barangay Nutrition Scholar Name & signature of Midwife

Date Date

OPT Plus Form 1 List of preschoolers with height measurement and identified Nutritional Status

Barangay Municipality: LAL-LO Province : CAGAYAN Year: Date of OPT Plus:

Househol Name of Household Head Name of Preschooler Sex Date of Birth Age in Weight Length Nutritional Status
d Mother/Caregiver (Yr-Mo-Day) Month (kg) Height
Number Birthday Measurement s (cm) Weight Length/ Weight for
for Ht for Length/
Age Age Height

N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
  Codes For nutritional Status Weight For Age N-Normal UW-Underweight SUW-Severely Underweight OW-Overweight
Length/Height for Age N-Normal St-Stunting SST-Severely Stunting T-Tall
Weight for Length/Height N-Normal W-Wasted SW-Severely Wasted OW-Overweight OB-Obese
“Age in months” always refers to completed number of months i.e. 34 month and 30 days is considered 34 months only

Prepared by Checked by
Name & Signature of Barangay Nutrition Scholar Name & signature of Midwife

Date Date

OPT Plus Form 1 List of preschoolers with height measurement and identified Nutritional Status

Barangay Municipality: LAL-LO Province : CAGAYAN Year: Date of OPT Plus:

Househol Name of Household Head Name of Preschooler Sex Date of Birth Age in Weight Length Nutritional Status
d Mother/Caregiver (Yr-Mo-Day) Month (kg) Height
Number Birthday Measurement s (cm) Weight Length/ Weight for
for Ht for Length/
Age Age Height

N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
 N N N
N N N

 Codes For nutritional Status Weight For Age N-Normal UW-Underweight SUW-Severely Underweight OW-Overweight
Length/Height for Age N-Normal St-Stunting SST-Severely Stunting T-Tall
Weight for Length/Height N-Normal W-Wasted SW-Severely Wasted OW-Overweight OB-Obese
“Age in months” always refers to completed number of months i.e. 34 month and 30 days is considered 34 months only

Prepared by Checked by
Name & Signature of Barangay Nutrition Scholar Name & signature of Midwife

Date Date

OPT Plus Form 1 List of preschoolers with height measurement and identified Nutritional Status

Barangay Municipality: Saguiaran Province Lanao Del Sur Year: Date of OPT Plus:

Househol Name of Household Head Name of Preschooler Sex Date of Birth Age in Weight Length Nutritional Status
d Mother/Caregiver (Yr-Mo-Day) Month (kg) Height
Number Birthday Measurement s (cm) Weight Length/ Weight for
for Ht for Length/
Age Age Height

N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
 N N N
N N N
N N N
N N N
N N N
N N N

 Codes For nutritional Status Weight For Age N-Normal UW-Underweight SUW-Severely Underweight OW-Overweight
Length/Height for Age N-Normal St-Stunting SST-Severely Stunting T-Tall
Weight for Length/Height N-Normal W-Wasted SW-Severely Wasted OW-Overweight OB-Obese
“Age in months” always refers to completed number of months i.e. 34 month and 30 days is considered 34 months only

Prepared by Checked by
Name & Signature of Barangay Nutrition Scholar Name & signature of Midwife

Date Date

OPT Plus Form 1 List of preschoolers with height measurement and identified Nutritional Status

Barangay Municipality: LAL-LO Province : CAGAYAN Year: Date of OPT Plus:

Househol Name of Household Head Name of Preschooler Sex Date of Birth Age in Weight Length Nutritional Status
d Mother/Caregiver (Yr-Mo-Day) Month (kg) Height
Number Birthday Measurement s (cm) Weight Length/ Weight for
for Ht for Length/
Age Age Height

N N N
N N N
N N N
N N N
N N N
N N N
 N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N

 Codes For nutritional Status Weight For Age N-Normal UW-Underweight SUW-Severely Underweight OW-Overweight
Length/Height for Age N-Normal St-Stunting SST-Severely Stunting T-Tall
Weight for Length/Height N-Normal W-Wasted SW-Severely Wasted OW-Overweight OB-Obese
“Age in months” always refers to completed number of months i.e. 34 month and 30 days is considered 34 months only

Prepared by Checked by
Name & Signature of Barangay Nutrition Scholar Name & signature of Midwife

Date Date

OPT Plus Form 1 List of preschoolers with height measurement and identified Nutritional Status

Barangay Municipality: LAL-LO Province : CAGAYAN Year: Date of OPT Plus:

Househol Name of Household Head Name of Preschooler Sex Date of Birth Age in Weight Length Nutritional Status
d Mother/Caregiver (Yr-Mo-Day) Month (kg) Height
Number Birthday Measurement s (cm) Weight Length/ Weight for
for Ht for Length/
Age Age Height

N N N
N N N
N N N
 N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N
N N N

 Codes For nutritional Status Weight For Age N-Normal UW-Underweight SUW-Severely Underweight OW-Overweight
Length/Height for Age N-Normal St-Stunting SST-Severely Stunting T-Tall
Weight for Length/Height N-Normal W-Wasted SW-Severely Wasted OW-Overweight OB-Obese
“Age in months” always refers to completed number of months i.e. 34 month and 30 days is considered 34 months only

Prepared by Checked by
Name & Signature of Barangay Nutrition Scholar Name & signature of Midwife

Date Date