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59 views1 page

BNS Opt

Uploaded by

Alibtak Dly
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL

OPT Plus form 1 . List of Preschoolers with Weight and Height measurements and identified nutritional status
Series 2012
Barangay: PUG-OS (DLY) Municipality : SINAIT Province: ILOCOS SUR Year : _______ Date of OPT Plus :_______________________

Date of (Yr-Mo-Day) Nutritional Status


Name of Household Age in Weight Length/
Purok Name of Preschooler Sex Weight for Length/Ht Weight for
Head/Mother/Caregiver Birthday Measurement Months (kg) Height(cm)
Age for Age Length/Height
Weight Height/Length
(1) (2) (3) (4) (5) (8) (9) (10) (11) (12) (13)
(6) (7)

Prepared by: __________________________________________________ Checked by: _______________________________________________


Name & Signature of Barangay Nutrition Scholar Name & Signature of Midwife/Nurse/District Nutrition Program Coordinator

Date: _________________________________ Date : _____________________________________

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