Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL
OPT Plus Form 1. List of preschoolers with weight and height measurement and identified Nutritional Status
Revised February 2012
Barangay: ____________ City/Municipality: _________ Province: _________+ Year: ______ Date of OPT Plus: ____________

Purok Household Name of Name of Sex Date of (Yr-Mo-Day) Age in Weight Length/ Nutritional Status*
Number Household Head/ Preschooler Birthday Measurement Months (kg) Height Weight Length/ Weight for
Mother/ (cm) for Age Ht for Age Length/
Weight Length/
Caregiver Height
Height
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

*Codes: for nutritional status: Weight-for-age: N-Normal UW-Underweight SUW- Severely Underweight OW-Overweight *Note: Use WEIGHT-FOR-LENGTH for 0-23months old preschool children and
Length/Height-for-Age: N-Normal St-Stunting SSt-Severely Stunting T-Tall WEIGHT- FOR-HEIGHT for 24-60 months old preschool children
Weight-for-Length/Height: N-Normal W-Wasted SW-Severely Wasted OW-Overweight Ob-Obese Use WEIGHT-FOR-LENGTH or WEIGHT-FOR-HEIGHT to correctly
determine overweight and obesity.
'1/"Age-in-months" refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only.

Prepared By: _______________________________________________ Checked : ________________________________________________

Name and Signature of Barangay Nutrition Scholar Name and Signature of Municipal Nutrition Action Officer

Date: ___________________________ Date: ___________________________