FC - Indacator (Height For Age)

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 4

DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT

SUPPLEMENTARY FEEDING PROGRAM

WEIGHT MONITORING FORM


HEIGHT-FOR-AGE
Name of CDC:
Name of CDW:
Location:

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 – 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

WEIGHT MONITORING FORM


HEIGHT-FOR-AGE
Name of CDC:
Name of CDW:
Location:

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

Legend: Prepared by:


SW – Severely Stunted
S – Stunted
N – Normal - CDW
T – Tall
WRNA – Weight Records Not Available

You might also like