FC - Indacator (Height For Age)
FC - Indacator (Height For Age)
FC - Indacator (Height For Age)
NUTRIONAL STATUS
No. Name of Children SEX UPON ENTRY/INITIAL After _____ days _______to After ____ days _______to
Date of Age Height Weight Nutrition Date of Age Height Weight Nutrition Date of Age Height Weight Nutrition
Weighting (in mo.) (in cm) (in kls) Status Weighting (in mo) (in cm) (in kls) Status Weighting (in mo) (in cm) (in kls) status
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20.
Legend: Prepared by: Certified by:
SW – Severely Stunted
S – Stunded - CDW ____________________
N – Normal Name/Position Name/Position
T – Tall
WRNA – Weight Records Not Available
DROOPED – Transferred Risedence Date
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
SUPPLEMENTARY FEEDING PROGRAM
NUTRIONAL STATUS
No. Name of Children SEX UPON ENTRY/INITIAL After _____ days _______to After ____ days _______to
Date of Age Height Weight Nutrition Date of Age Height Weight Nutrition Date of Age Height Weight Nutrition
Weighting (in mo.) (in cm) (in kls) Status Weighting (in mo) (in cm) (in kls) Status Weighting (in mo) (in cm) (in kls) status
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Legend: Prepared by: Certified by:
SW – Severely Stunted
S – Stanted - CDW ____________________
N – Normal Name/Position Name/Position
T – Tall
WRNA – Weight Records Not Available
DROOPED – Transferred Risedence Date
Department of Social Welfare and Development
Field Office IV-A
Supplementary Feeding Program
Summary of Nutritonal Status (Using Height-for-Age Indicator)
City/Municipality: ________________________
Province: _______________________________
School Year: ____________________________
UPON ENTRY
Date Date
Day Care Center No. of No. of No. of Feeding Feedings
DCCh Male Female Started Ends SS S N T Total
dd/mm/yyyy dd/mm/yyyy
Male Female Total Mal Female Total Male Female Tota Male Female Total Mal Female Total
e l e
CHILD
DEVELOPMENT
CENTER