OPT Plus Form 1.

List of preschoolers with weight and height measurement and identified Nutritional Status
Philippine Plan of Action for Nutrition

Barangay: _____________ City/ Municipality: Province: ______________

Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday

(1) (2) (3) (4) (5) (6)

OPT Plus Form 1. List of preschoolers with weight and height measurement and identified Nutritional Status
Philippine Plan of Action for Nutrition

Barangay: _____________ City/ Municipality: Province: ______________

Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday

(1) (2) (3) (4) (5) (6)

OPT Plus Form 1. List of preschoolers with weight and height measurement and identified Nutritional Status
Philippine Plan of Action for Nutrition

Barangay: _____________ City/ Municipality: Province: ______________

Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday

(1) (2) (3) (4) (5) (6)

OPT Plus Form 1. List of preschoolers with weight and height measurement and identified Nutritional Status
Philippine Plan of Action for Nutrition

Barangay: _____________ City/ Municipality: Province: ______________

Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday

(1) (2) (3) (4) (5) (6)

OPT Plus Form 1. List of preschoolers with weight and height measurement and identified Nutritional Status
Philippine Plan of Action for Nutrition

Barangay: _____________ City/ Municipality: Province: ______________

Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday

(1) (2) (3) (4) (5) (6)

OPT Plus Form 1. List of preschoolers with weight and height measurement and identified Nutritional Status
Philippine Plan of Action for Nutrition

Barangay: _____________ City/ Municipality: Province: ______________

Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday

(1) (2) (3) (4) (5) (6)

OPT Plus Form 1. List of preschoolers with weight and height measurement and identified Nutritional Status
Philippine Plan of Action for Nutrition

Barangay: _____________ City/ Municipality: Province: ______________

Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday

(1) (2) (3) (4) (5) (6)

OPT Plus Form 1. List of preschoolers with weight and height measurement and identified Nutritional Status
Philippine Plan of Action for Nutrition

Barangay: _____________ City/ Municipality: Province: ______________

Purok Household Name of Household/ Head/ Mother/ Name of Preschooler Sex Date of (Yr-Mo-Day)
Number Caregiver
Birthday

(1) (2) (3) (4) (5) (6)

* 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
1/
"Age in months" refers to completed number of months. For instance, 34 months and 27 days is considered 34 months only

Prepared by:
Name and Signature of Barangay Nutrition Scholar

Date:
ce: _________________ Year: _________ Date of OPT Plus: _____________

Date of (Yr-Mo-Day) Age in Weight Length/ Nutritional Status

months1 (kg) Height
Measurement (cm) Weight Length/ Weight
Weight Length/ for age Height for
Height for age Length/

(7) (8) (9) (10) (11) (12) (13) (14)

ce: _________________ Year: _________ Date of OPT Plus: _____________

Date of (Yr-Mo-Day) Age in Weight Length/ Nutritional Status

months1 (kg) Height
Measurement (cm) Weight Length/ Weight
Weight Length/ for age Height for
Height for age Length/

(7) (8) (9) (10) (11) (12) (13) (14)

ce: _________________ Year: _________ Date of OPT Plus: _____________

Date of (Yr-Mo-Day) Age in Weight Length/ Nutritional Status

months1 (kg) Height
Measurement (cm) Weight Length/ Weight
Weight Length/ for age Height for
Height for age Length/

(7) (8) (9) (10) (11) (12) (13) (14)

ce: _________________ Year: _________ Date of OPT Plus: _____________

Date of (Yr-Mo-Day) Age in Weight Length/ Nutritional Status

months1 (kg) Height
Measurement (cm) Weight Length/ Weight
Weight Length/ for age Height for
Height for age Length/

(7) (8) (9) (10) (11) (12) (13) (14)

ce: _________________ Year: _________ Date of OPT Plus: _____________

Date of (Yr-Mo-Day) Age in Weight Length/ Nutritional Status

months1 (kg) Height
Measurement (cm) Weight Length/ Weight
Weight Length/ for age Height for
Height for age Length/

(7) (8) (9) (10) (11) (12) (13) (14)

ce: _________________ Year: _________ Date of OPT Plus: _____________

Date of (Yr-Mo-Day) Age in Weight Length/ Nutritional Status

months1 (kg) Height
Measurement (cm) Weight Length/ Weight
Weight Length/ for age Height for
Height for age Length/

(7) (8) (9) (10) (11) (12) (13) (14)

ce: _________________ Year: _________ Date of OPT Plus: _____________

Date of (Yr-Mo-Day) Age in Weight Length/ Nutritional Status

months1 (kg) Height
Measurement (cm) Weight Length/ Weight
Weight Length/ for age Height for
Height for age Length/

(7) (8) (9) (10) (11) (12) (13) (14)

ce: _________________ Year: _________ Date of OPT Plus: _____________

Date of (Yr-Mo-Day) Age in Weight Length/ Nutritional Status

months1 (kg) Height
Measurement (cm) Weight Length/ Weight
Weight Length/ for age Height for
Height for age Length/

(7) (8) (9) (10) (11) (12) (13) (14)

Note: Use WEIGHT-FOR-LENGTH for 0--23 months old preschool and

WEIGHT-FOR-HEIGHT for 24-60 months old preschool children
Use WEIGHT-FOR-LENGTH or WEIGHT-FOR-HEIGHT to correctly
determine overweight and obesity.

Checked:
Name and Signature of Midwife/ Nurse/ District/ City
Nutrition Program Coordinator
Date: