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: ______
____________
Puro
k

Househol
d Number

Name of
Household
Head/
Mother/
Caregiver

Name of
Preschoo
ler

Se
x

(1)

(2)

(3)

(4)

(5)

Date of (Yr-Mo-Day)
Birthd Measurement
ay
Weig Lengt
ht
h/
Heigh
t
(6)
(7)
(8)

Age
in
Mont
hs

Weig
ht
(kg)

Lengt
h/
Heig
ht
(cm)

(9)

(10)

(11)

Date of OPT Plus:

Nutritional Status*
Weig Length/
Weight
ht for
Ht for
for
Age
Age
Length/
Height
(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 023months 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 WEIGHTFOR-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: _______________________________________________

Name and Signature of Barangay Nutrition Scholar
Nutrition Action Officer

Checked : ________________________________________________
Name and Signature of Municipal

Date: ___________________________

Date: ___________________________