BNS Form No.
1B
Philippine Plan of Action for Nutrition
NUTRITIONAL STATUS, FEEDING AND MICRONUTRIENT SUPPLEMENTATION RECORD OF PRESCHOOL CHILDREN
Purok/Sitio: ____________________ Municipality: ____________________
Barangay: ________________________ City/Province:____________________
HH Name of Father and Mother Name of Child Date of Birth Age in Weight Height NUTRITIONAL STATUS Practicing SOLID FOOD FEEDING MICRONUTRIENT
No. EBF if
(mm/dd/yyyy) months (kg) (cm) SUPPLEMENTATION
child is
<6 mos.
Date of OPT Weight Length/ Weight
Old (Y/N)
Practicing Age in Current Vitamin Iron Using
for Age¹ Height for CF if child months beneficiary A last drops/ MNP
Plus
for age² length/ is ≥6 mos. started of SF date Syrup
(mm/dd/yyyy) (Y/N)
height³ – 23 mos. CF (Y/N) received received
Old (Y/N) (Y/N)
Y N Y N Y N Y N Y N
(F) DOB
(M) DOOPlus
(F) DOB
(M) DOOPlus
(F) DOB
(M) DOOPlus
(F) DOB
(M) DOOPlus
(F) DOB
(M) DOOPlus
(F) DOB
(M) DOOPlus
(F) DOB
(M) DOOPlus
(F) DOB
(M) DOOPlus
(F) DOB
(M) DOOPlus
(F) DOB
(M) DOOPlus
Abbreviations
HH – Household EBF – Exclusive Breastfeeding SF – Supplemental Feeding DOB – Date of Birth
CF – Complimentary Feeding MNP – Micronutrient Powder DOOPlus – Date of OPT Plus
¹Weight for age ²²Length/Height for age ³Weight for length/height
SUW Severely Underweight SSt Severely Stunted SUW Severely Underweight
UW Underweight St Stunted UW Underweight
N Normal N Normal N Normal
OW Overweight T Tall OW Overweight
Ob Obese