Revised OPT Forms Ver Jan2012 BgyregFINAL

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
Series 2012
Barangay: _______________________
Household
Name of Household Head/
Number
Mother/Caregiver
(1)
* Codes: for nutritional status:
City/Municipality: _____________________
Name of Preschooler
(2)
Weight-for-Age: N- Normal
Sex
(3)
UW- Underweight
Length/Height-for-Age: N- Normal
Weight-for-Length/Height: N- Normal
St - Stunting
W- Wasted
(4)
SUW- Severely Underweight

SSt - Severely Stunting
SW- Severely Wasted
Province: __________________
Year: ______
Date of OPT Plus: __________
Date of
Age in
Weight
Length/
(Yr-Mo-Day)
Months
(kg)
Height
Birthday
Measurement
(5)
(6)
(7)
(8)
Nutritional Status*
Weight for
Length/
Weight for
(cm)
Age
Ht for Age
Length/Height
(9)
(10)
(11)
(12)
OW- Overweight
T- Tall
OW- Overweight
Ob- Obese
"Age-in-months" always refers to completed number of months, i.e. 34 months and 30 days is considered 34 months only.
1/
Prepared By: _____________________________________________

Name & Signature of Barangay Nutrition Scholar
Date: __________________________
Checked: ______________________________________________
Name & Signature of Midwife/Nurse/District/City Nutrition Program Coordinator
Date: __________________________

OPT Plus Form 1. List of preschoolers with weight and height measurement and identified Nutritional Status
Series 2012
Barangay:
_______________________
Household
Number
Mother/Caregiver
(1)
* Codes: for nutritional status:
Year: ______
Date of (Yr-Mo-Day)
Name of Preschooler
(2)
Weight-for-Age: N- Normal
Province: __________________
Sex
(3)
UW- Underweight
Length/Height-for-Age: N- Normal
Weight-for-Length/Height: N- Normal
St - Stunting
W- Wasted
(4)
SUW- Severely Underweight

SSt - Severely Stunting
SW- Severely Wasted
Birthday
(5)
Measurement
Weight
Length/Height
(6)
(7)
Date of OPT Plus: __________
Age in
Weight
Length/
Months
(kg)
Height
Weight for
Length/
Weight for
(cm)
Age
Ht for Age
Length/Height
(10)
(11)
(12)
(13)
(8)
(9)
Nutritional Status*
OW- Overweight
T- Tall
OW- Overweight
Ob- Obese
"Age-in-months" always refers to completed number of months, i.e. 34 months and 30 days is considered 34 months only.
1/
Prepared By: _____________________________________________

Date: __________________________
Checked: ______________________________________________
Date: __________________________

OPT Plus Form 1A. Barangay Tally and Summary Sheet of Preschoolers with Weight & Height Measurement by Age Group, Sex and Nutritional Status
Series 2012 Page 1 of 3
Barangay: ____________________________
Province: ____________________________
Age
Group
(1)
0-5
months
(R1)
6-11
months
(R2)
12-23
months
(R3)
24-35
months
(R4)
36-47
months
(R5)
48-59
months
(R6)
60-71
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos
Normal (N)
Boys
(2)
(3)
Girls
(4)
Note: a) R1 means Row No. 1, R2 means Row 2, etc.
(5)
Estimated Number of Preschoolers: 0-59 months old _________ 0-71 months old: ________
Actual Number of Preschoolers Weighed: 0-59 months old _________ 0-71 months old _________
Percent OPT Plus Coverage: 0-59 months old ___________________ 0-71 months old _________
Number of Indigenous PS measured: 0-59 mos old __________ 0-71 mos old ____________
Weight for Age Status
Underweight (UW)
Severely Underweight (SUW)
Overweight (OW)
Boys
Girls
Boys
Girls
Boys
Girls
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
b)Total (R8) - refers to the sum of preschoolers by nutritional status and by age group
d) Prev (C21,23,25,27)- refers to the prevalence rate by total by age group
Year/Period of Measurement _________ CY20__ Prev*: _______

Indigenous group (specify if applicable): __________________
Boys
(18)
TOTAL
Girls
(19)
N
Total
(20)
No
(21)
Prev
(22)
Total, by age group

UW
SUW
No
Prev
No
Prev
(23)
(24)
(25)
(26)
.
c) Prev (R9)- refers to the prevalence rate by sex, by nutritional status for age group 0- 59 months and 0- 71 months
* refers to previous year prevalence rate of the area
OVERWEIGHT IS MORE CORRECTLY DETERMINED USING WEIGHT-FOR-LENGTH OR WEIGHT-FOR-HEIGHT.

Prepared by: ________________________________________
Date:
Checked: ___________________________________________
Name & Signature of Midwife/Nurse/
District/City Nutrition Program Coordinator
Date: __________________________________________
Approved: ____________________________________
Name & Signature of Barangay Captain,
BNC Chairperson
Date:
OW
No
(27)
Prev
(28)

Barangay: ____________________________
Province: ____________________________
Age
Group
Normal (N)
Boys
(1)
0-5
months
(R1)
6-11
months
(R2)
12-23
months
(R3)
24-35
months
(R4)
36-47
months
(R5)
48-59
months
(R6)
60-71
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos
(2)
Girls
(3)
(4)
(5)
Actual Number of Preschoolers Weighed: 0-59 months old _________ 0-71 months old:_________
Percent OPT Plus Coverage: 0-59 months old ____________________ 0-71 months old:_________
Length/Height for Age Status
Stunted /Short (St)
Severely Stunted (SSt)
Tall (T)
Boys
Girls
Boys
Girls
Boys
Girls
Boys
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
Prepared by: ________________________________________

Date:

TOTAL
Girls
(19)
N
Total
(20)
No
(21
Prev
(22)
Total, by age group

St
SSt
No
Prev
No
Prev
(23)
(24)
(25)
(26)
.
Checked: ___________________________________________
Date: __________________________________________
Approved: ____________________________________
BNC Chairperson
Date:
T
No
(27)
Prev
(28)

Barangay: ____________________________
Province: ____________________________
Age
Group
(1)
0-5
months
(R1)
6-11
months
(R2)
12-23
months
(R3)
24-35
months
(R4)
36-47
months
(R5)
48-59
months
(R6)
60-71
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos
Normal (N)
Boys
Girls
(2) (3)
(4)
(5)
Actual Number of Preschoolers Weighed: 0-59 months old _________ 0-71 months old: _________
Percent OPT Plus Coverage: 0-59 months old ___________________ 0-71 months old:_________
Weight for Length/Height Status
Total, by age group
Wasted (W)
Severely Wasted (SW)
Overweight (OW)
Obese (Ob)
TOTAL
N
W
SW
OW
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Boys Girls
Total
No
Prev
No
Prev
No
Prev
No
Prev
(6)
(7)
(8)
(9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22)
(23)
(24)
(25)
(26)
(27)
(28)
(29)
(30)
(31)
(32)
Prepared by: ________________________________________

Date:
Checked: ___________________________________________
Date: __________________________________________
Approved: ____________________________________
BNC Chairperson
Date:
Ob
No
(33)
Prev
(34)

OPT Plus Form 1B. List of Affected/At-risk Preschoolers 0-71 Months old
Series 2012
Barangay: ___________________________________
City/Municipality: _____________________________
Province: ________________________________
Year/Period of Measurement _____________
Instructions:
In column 1, copy the household number from the Family Profile.
In column2, write the family name first, followed by name of the household head.
In column 3, write the first name of the preschool child only.
In column 4, write "B" for boy and "G" for girl.
In column 5, write "NA" if not applicable, specify specific indegenous group/tribe.

In column 6, indicate the age in months based on last completed month.
In column 7-14, check the appropriate nutritional status.
Household
Number

Mother/Caregiver
Name of Preschooler
(1)
(2)
(3)
Prepared by: ______________________________________

_______________________________________
(4)
Indigenous Age in
Group
months
(5)
(6)
Checked: ___________________________________________
Date
Sex
UW
SUW
St
Nutritional Status
SSt
W
(7)
(8)
(9)
(10)
(12)
OW
(13)
____________________________________
BNC Chairperson
Date
Page 6 of 23
SW
Approved: _________________________________
Date
(11)
_____________________________
Ob
(14)

OPT Plus Form 2. City/Municipal Consolidation Sheet of Operation Timbang Plus Results
Series 2012
Page 1 of 4
Series 2012
City/Municipality SINILOAN
Province LAGUNA
Total No. of Barangays 20

Total No. of Barangays with OPT Plus Results ___________
Normal Weight-for-Age
Please check:
Year/Period of Measurement 2014

Indigenous Group/s: ___________________
Number of Indigenous PS measured: 0-59 mos old ______ 0-71 mos old _______
Normal Length/Height-for-Age
Normal Weight-for-Length/Height
Page 2 of 4
Province LAGUNA

Total No. of Barangays with OPT Results 20
Please Check:
Underweight Weight-for-Age
Total Number of Children

Stunted Length/Height-for-Age
Wasted Weight-for-Length/Height
(2)
168
(3)
122
(4)
2.71
Boys
(5)
5
Girls
(6)
3
Boys
(7)
7
Girls
(8)
3
Boys
(9)
13
Girls
(10)
8
Boys
(11)
14
Girls
(12)
13
Boys
(13)
12
Girls
(14)
10
Boys
(15)
7
Girls
(16)
9
Boys
(17)
6
Girls
(18)
12
BUHAY
(2)
168
(3)
34
(4)
0.75
Boys
(5)
2
Girls
(6)
0
Boys
(7)
0
Girls
(8)
0
Boys
(9)
1
Girls
(10)
1
Boys
(11)
1
Girls
(12)
9
Boys
(13)
6
Girls
(14)
3
Boys
(15)
4
Girls
(16)
3
Boys
(17)
0
Girls
(18)
4
656
302
506
209
11.22
4.64
20
8
21
9
29
9
22
8
38
20
31
12
49
24
40
9
54
31
40
11
40
21
43
16
34
13
45
18
MENDILA
BURGOS
656
302
100
44
2.22
0.98
2
1
1
2
2
0
0
1
15
4
4
1
6
2
9
6
10
4
9
8
13
2
8
3
15
6
1
4
PANDEO
329
308
6.83
11
11
27
25
31
25
40
25
26
24
24
23
PANDEO
329
11
0.24
GEN. LUNA
BAGONG PAG-ASA
212
36
128
35
2.84
0.78
5
2
6
3
3
1
8
1
13
2
7
2
9
2
12
5
10
4
6
3
8
2
15
3
9
3
17
2
GEN. LUNA
BAGONG PAG-ASA
212
36
42
1
0.93
0.02
1
0
0
0
0
0
2
0
1
0
6
0
5
0
8
0
7
0
2
0
2
0
2
0
WAWA
J. RIZAL
380
33
273
33
6.06
0.73
16
0
15
2
14
0
15
1
18
0
23
4
18
3
17
4
24
4
26
5
23
2
17
1
27
3
20
4
WAWA
J. RIZAL
380
33
71
0
1.57
0.00
0
0
0
0
0
0
0
0
4
0
4
0
9
0
12
0
5
0
8
0
8
0
7
0
ACEVIDA
SALUBUNGAN
147
203
112
194
2.48
4.3
5
10
1
4
5
8
4
9
5
24
4
10
8
21
7
12
18
17
11
21
13
21
10
15
15
10
6
12
ACEVIDA
SALUBUNGAN
147
203
19
8
0.42
0.18
0
0
0
0
0
0
0
0
3
0
2
2
2
0
2
2
2
2
0
1
0
0
HALAYHAYIN
600
426
9.45
31
27
24
18
36
35
42
15
33
38
28
33
29
37
HALAYHAYIN
600
94
2.09
15
15
(1)
12-23 months
24-35 months
36-47 months
48-59 months
60-71 months
Estimated No. of
071 months old
Preschool children
Barangay
(1)
Total No of
0-71 months old PS
measured
Prev
%
0-5 months
6-11 months
12-23 months
Page 4 of 4
Province LAGUNA

Please check:
Overweight Weight-for-Age
24-35 months
36-47 months
Estimated No. of
071 months old
Preschool children
Total No of
0-71 months old PS
measured
BUHAY
(2)
168
(3)
7
(4)
0.16
Boys
(5)
0
Girls
(6)
1
Boys
(7)
0
Girls
(8)
0
Boys
(9)
0
Girls
(10)
0
Boys
(11)
2
Girls
(12)
0
Boys
(13)
0
Girls
(14)
1
Boys
(15)
2
Girls
(16)
0
Boys
(17)
0
Girls
(18)
1
MENDILA
BURGOS
656
302
63
38
1.40
0.84
2
1
1
0
1
3
1
2
8
3
9
4
12
4
2
2
7
3
3
4
3
8
4
2
5
2
5
0
PANDEO
329
0.09
2
1
4
0
GEN. LUNA
BAGONG PAG-ASA
212
36
34
0
0.75
0.00
0
0
0
0
3
0
1
0
4
0
5
0
1
0
0
0
5
0
5
0
1
0
2
0
7
0
7
0
WAWA
J. RIZAL
380
33
31
0
0.69
0.00
0
0
0
0
1
0
0
0
4
0
2
0
0
0
7
0
3
0
2
0
4
0
4
0
3
0
2
0
3
1
ACEVIDA
SALUBUNGAN
147
203
6
1
0.13
0.02
0
0
0
0
0
0
0
0
0
0
1
0
0
0
2
0
1
0
0
0
0
1
15
HALAYHAYIN
600
50
1.11
48-59 months
60-71 months
Barangay
(1)
Prev
%
0-5 months
6-11 months
12-23 months

Obese Weight-for-Length/Height
Tall Length/Height-for-Age
MENDILA
BURGOS
6-11 months

Sev.
Sev. Wasted Weight-for-Length/Height
Sev. UW Weight-for-Age
BUHAY
0-5 months

Please check:
Total No of
0-71 months old PS
measured
Prev
Series 2012
3 of 4
Province LAGUNA
Estimated No. of
071 months old
Preschool children
Barangay
Series 2012 Page
24-35 months
36-47 months
Estimated No. of
071 months old
Preschool children
Total No of
0-71 months old PS
measured
BUHAY
(2)
168
(3)
5
(4)
0.11
Boys
(5)
1
Girls
(6)
2
Boys
(7)
0
Girls
(8)
0
Boys
(9)
0
Girls
(10)
0
Boys
(11)
0
Girls
(12)
1
Boys
(13)
0
Girls
(14)
0
Boys
(15)
0
Girls
(16)
0
Boys
(17)
0
Girls
(18)
1
MENDILA
BURGOS
656
302
7
11
0.16
0.24
1
2
2
0
0
1
0
0
3
1
0
0
0
4
0
1
0
0
1
1
0
0
0
0
0
1
0
0
PANDEO
329
0.13
7
0
0
0
GEN. LUNA
BAGONG PAG-ASA
212
36
8
0
0.18
0.00
1
0
4
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
WAWA
J. RIZAL
380
33
5
0
0.11
0.00
3
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
ACEVIDA
SALUBUNGAN
147
203
10
0
0.22
0.00
6
0
2
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
0
0
HALAYHAYIN
600
10
0.22
48-59 months
60-71 months
Barangay
(1)
Prev
%
0-5 months
6-11 months
12-23 months
24-35 months
36-47 months
48-59 months
60-71 months
BAGUMBARANGAY
13
10
0.22
BAGUMBARANGAY
13
0.00
BAGUMBARANGAY
13
0.00
BAGUMBARANGAY
13
0.07
G. REDOR
104
52
1.15
12
G. REDOR
104
20
0.44
G. REDOR
104
31
0.69
G. REDOR
104
0.02
MACATAD
320
134
2.97
12
13
12
10
19
11
19
MACATAD
320
81
1.80
18
17
MACATAD
320
85
1.89
11
11
10
MACATAD
320
20
0.44
MAYATBA
80
50
1.11
11
MAYATBA
80
13
0.29
MAYATBA
80
15
0.33
MAYATBA
80
0.04
LAGUIO
101
75
1.66
LAGUIO
101
18
0.40
LAGUIO
101
0.13
LAGUIO
101
0.04
LIYANG
93
82
1.83
10
13
LIYANG
93
0.20
LIYANG
93
0.04
LIYANG
93
0.00
KAPATALAN
311
234
5.19
26
14
23
16
38
12
21
20
20
22
KAPATALAN
311
55
1.22
KAPATALAN
311
15
0.33
KAPATALAN
311
0.16
MAGSAYSAY
LLAVAC
216
204
130
133
2.88
2.95
6
8
10
3
3
7
5
4
13
4
14
7
7
12
5
16
13
11
16
13
11
17
9
9
11
11
7
11
MAGSAYSAY
LLAVAC
216
204
51
48
1.13
1.06
0
3
1
3
2
0
0
3
5
0
5
5
3
7
4
5
4
4
10
3
3
3
3
4
5
2
6
6
MAGSAYSAY
LLAVAC
216
204
31
20
0.69
0.44
0
0
0
0
1
0
1
2
2
0
1
2
4
2
4
6
3
1
1
3
3
1
3
0
7
3
1
0
MAGSAYSAY
LLAVAC
216
204
4
3
0.09
0.07
1
0
2
0
0
0
0
0
1
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4508
3246
72.00
147
135
146
131
269
244
302
228
332
274
274
256
249
259
TOTAL
4508
719
15.94
13
12
11
11
54
42
67
87
79
85
60
56
77
60
TOTAL
4508
439
9.73
14
12
47
33
47
43
49
40
37
37
46
21
TOTAL
4508
104
2.30
27
29
13
TOTAL
FLOREAN A. VISITACION
Prepared by ___________________________________________
DRA. GIRANY A. FARIAS

Approved ___________________________________________
Name & Signature of DCNPC/Nutritionist/C/MNAO
Name & Signature of City/Municipal Health Officer
___________________________________________
__________________________________________
EDUARDO RAMOS TIBAY

Noted: _____________________________________
Name & Signature of Mayor,
Prepared by ___________________________________________

Approved ___________________________________________
___________________________________________
__________________________________________
City/Municipal Nutrition Committee

Date
Date
_____________________________________
Date
EDUARDO RAMOS TIBAY

Noted: _____________________________________
Prepared by ___________________________________________

Approved ___________________________________________
___________________________________________
__________________________________________

Date
Date
_____________________________________
Date
EDUARDO RAMOS TIBAY

Noted: _____________________________________
Prepared by ___________________________________________

Approved __________________________________________
___________________________________________
__________________________________________

Date
Date
_____________________________________
Date
EDUARDO RAMOS TIBAY

Noted: _____________________________________
Date
Date
_____________________________________
Date


OPT Plus Form 2A. City/Municipality Summary Report on Operation Timbang Plus
City/Municipality:
SINILOAN
Province:
LAGUNA
Region:
IV - A
Indigenous Group/s: ____________________
Age
Group
Normal (N)
Boys
Girls
(1)
(2)
(3)
(4)
(5)
0-5
203
172
months
(R1)
203
172
6-11
153
133
months
(R2)
153
133
12-23
356
295
months
(R3)
356
295
24-35
372
345
months
(R4)
372
345
36-47
409
358
months
(R5)
409
358
48-59
335
312
months
(R6)
335
312
60-71
313
317
months
(R7)
313
317
Total (R8)
0-59 mos
1828
1715
0-71 mos
2141
1922
Prev (R9)
0-59 mos
48.13
45.16
0-71 mos
47.49
42.64
Total No of Barangays:
20
Total No. of Barangays with OPT Results:
20
Year/Period of Measurement
2014
Previous Year Prevalence Rate: _________________
Boys
Girls
(10)
(11)
(12)
(13)
2
1
Underweight (UW)
Boys
Girls
(6)
(7)
(8)
(9)
2
2
2
5
2
6
30
32
23
40
163
142
305
2.86
6.34
11
0.24
0.11
40
31
401
315
716
651
14.44
48
1.06
12
0.27
0.11
418
381
799
717
15.91
53
1.18
20
0.44
0.20
4
4
13
6
4
4
7
6
4
3
31
32
6
7
6
5
3
2
32
131
173
115
147
42
49
30
35
3.45
3.84
3.03
3.26
1.11
1.09
0.79
0.78
867
767
17.01
72
1.6
20
0.44
0.18
352
721
647
14.37
58
1.29
12
0.27
0.09
3
2
364
42
409
4
3
369
27
42
0.07
458
32
27
0.18
9
7
3
3
11
13
0
3
4
9
Total OW
No
Prev
(27)
(28)
3
4
8
11
3
0
2
8
13
23
3,798 0-71 months old: ________

4,508
Estimated Number of Preschoolers: 0-59 months old _________
3,798 0-71 months old _________
4,508
Actual Number of Preschoolers measured: 0-59 months old _________
100%
100%
Percent OPT Plus Coverage: 0-59 months old ____________________
0-71 months old _________
Total, by age group
TOTAL
Total N
Total UW
Total SUW
Boys
Girls
Total
No
Prev
No
Prev
No
Prev
(18)
(19)
(20)
(21)
(22)
(23)
(24)
(25)
(26)
.
212
178
390
375
8.32
4
0.09
3
0.07
3
Overweight (OW)
Boys
Girls
(14)
(15)
(16)
(17)
3
3
1
3
6
13
35
30
2
2
5
35

346
710
620
13.75
74
1.64
12
0.27
0.09
20
22
17
19
2021
2385
1777
2123
3798
4508
0.53
0.49
0.45
0.42
53.21
52.91
46.79
47.09
100%
100%
3443
4063
76.88
90.13
246
320
5.46
7.1
72
84
1.6
1.86
37
41
0.82
3.91
City/Municipality:
SINILOAN
Province:
LAGUNA
Region:
IV - A
Age
Group
Normal (N)
Boys
Girls
(1)
(2)
(3)
(4)
(5)
0-5
147
135
months
(R1)
147
135
6-11
146
131
months
(R2)
146
131
12-23
269
244
months
(R3)
269
244
24-35
302
228
months
(R4)
302
228
36-47
332
274
months
(R5)
332
274
48-59
274
256
months
(R6)
274
256
60-71
249
259
months
(R7)
249
259
Total (R8)
0-59 mos
1470
1268
0-71 mos
1719
1527
Prev (R9)
0-59 mos
38.80
33.47
0-71 mos
38.13
33.87
3,798 0-71 months old: ________

4,508
Total No of Barangays:
20
3,798 0-71 months old _________
4,508
Total No. of Barangays with OPT Results:
20
100%
100%
Percent OPT Plus Coverage: 0-59 months old ____________________
0-71 months old _________
Year/Period of Measurement
2014
Total, by age group
Tall (T)
TOTAL
Total N
Total St
Total SSt
Boys
Girls
Boys
Girls
Boys
Girls
Girls
No
Prev
No
Prev
No
Prev
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)
(21
(22)
(23)
(24)
(25)
(26)
6
4
27
29
.
193
180
373
282
6.26
25
0.55
10
0.22
12
6
4
27
29
11
14
12
8
1
179
155
334
277
6.14
22
0.49
26
0.58
11
14
12
8
1
42
47
33
13
5
383
324
707
513
11.38
96
2.13
80
1.77
42
47
33
13
5
87
47
43
6
5
422
363
785
530
11.76
154
3.42
90
2
87
47
43
6
5
85
49
43
3
2
463
404
867
606
13.44
164
3.64
92
2.04
85
49
43
3
2
56
37
37
0
3
371
352
723
530
11.76
116
2.57
74
1.64
56
37
37
0
3
65
46
21
1
1
373
346
719
508
11.27
142
3.15
67
1.49
65
46
21
1
1
Stunted /Short (St)

Boys
Girls
(6)
(7)
(8)
(9)
13
12
13
11
11
54
54
67
67
79
79
60
60
77
77
284
361
293
358
200
246
172
193
7.5
8.01
7.73
7.94
5.28
5.46
4.54
4.28
57
58
45
46
2011
2384
1778
2124
3789
4508
1.50
1.29
1.19
1.02
53.07
52.88
46.93
47.12
100%
100%
2738
3246
60.74
72.00
577
719
12.8
15.95
372
439
8.25
9.74
Total T
No
Prev
(27)
(28)
56
1.24
0.2
18
0.4
11
0.24
0.11
0.07
0.04
102
104
2.26
2.31
3,798 0-71 months old: ________

4,508
Total No of Barangays: _______________________
3,798 0-71 months old _________
4,508
Province: ____________________________
Total No. of Barangays with OPT Results: _________
100%
100%
Region: ____________________________
Percent OPT Plus Coverage: 0-59 months old __________
0-71 months old __________
Age
Total, by age group
Group
Normal (N)
Wasted (W)
Overweight (OW)
Obese (Ob)
TOTAL
Total N
Total W
Total SW
Total OW
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
Total
No
Prev
No
Prev
No
Prev
No
Prev
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22)
(23)
(24)
(25) (26) (27) (28) (29) (30) (31) (32)
0-5
174
162
4
9
7
7
16
14
18
10
months
219
202
421
336 7.45
13
0.28
14
0.31
30
0.67
(R1)
174
162
4
9
7
7
16
14
18
10
6-11
152
130
4
3
4
0
12
11
8
5
months
180
149
329
282 6.27
7
0.16
4
0.08
23
0.51
(R2)
152
130
4
3
4
0
12
11
8
5
12-23
349
275
11
10
11
10
16
14
6
8
months
393
317
710
624 13.84 21
0.47
21
0.47
30
0.67
(R3)
349
275
11
10
11
10
16
14
6
8
24-35
383
350
9
9
20
2
11
19
9
3
months
432
383
815
733 16.26 18
0.40
22
0.49
30
0.67
(R4)
383
350
9
9
20
2
11
19
9
3
36-47
425
388
9
7
11
2
10
13
10
6
months
465
416
881
813 18.03 16
0.35
13
0.29
23
0.51
(R5)
425
388
9
7
11
2
10
13
10
6
48-59
344
326
12
7
7
2
12
14
4
8
months
379
357
736
670 14.86 19
0.42
9
0.20
26
0.56
(R6)
344
326
12
7
7
2
12
14
4
8
60-71
291
283
4
9
4
3
7
7
5
3
months
311
305
616
574 12.73 13
0.29
7
0.16
14
0.30
(R7)
291
283
4
9
4
3
7
7
5
3
Total (R8)
0-59 mos
1827
1631
49
45
63
23
77
85
55
40
2068
1824
3892 3458 76.71 94
2.09
83
1.84 162 3.59
0-71 mos
2118
1914
53
54
64
26
84
92
60
43
2379
2129
4508 4032 89.44 107 2.37
90
2.00 176 3.90
Prev (R9)
0-59 mos
46.94
41.91
1.26
1.16
1.54
0.59
1.98
2.18
1.41
603 53.13 46.87 100%
0-71 mos
46.98
42.46
1.18
1.2
1.42
0.58
1.86
2.04
1.33
0.95 52.77 47.23 100%
Total Ob
No
(34)
28
0.62
13
0.29
14
0.30
12
0.27
16
0.35
12
0.27
0.18
95
103
2.11
2.28

Prepared by: __________________________________________________
Name & Signature of DCNPC/Nutritionist /C/MNAO
Date:

Checked: _________________________________________
Date:
EDUARDO RAMOS TIBAY

Approved: ____________________________________
Date: _______________________________
Prepared by: __________________________________________________

Date:

Checked: _________________________________________
Date:
EDUARDO RAMOS TIBAY

Approved: ____________________________________
Date: _______________________________
Prepared by:________________________________________________
Date:

Checked: ______________________________________________
Date:
Prev
(33)
EDUARDO RAMOS TIBAY

Approved: ___________________________
Date: _____________________

OPT Plus Form 3. Provincial Consolidation Sheet of Operation Timbang Plus Results
Series 2012
Page 1 of 4
Province ____________________
Total No. of Municipalities _________________________

Total No. of Municipalities with OPT Plus Results ___________
Please Check:
Municipality
(1)
Estimated No.
Total No of
of 0-71 mos old
0-71 mos old
Prev
PS
PS measured
(2)
(3)
(4)
0-5 months
Boys
Girls
(5)
(6)

6-11 months
Boys
Girls
(7)
(8)
12-23 months
Boys
Girls
(9)
(10)
24-35 months
Boys
Girls
(11)
(12)
36-47 months
Boys
Girls
(13)
(14)
48-59 months
Boys
Girls
(15)
(16)
60-71 months
Boys
Girls
(17)
(18)
TOTAL
Prepared by ___________________________________________
Name & Signature of DCNPC/Nutritionist/PNAO
Approved ___________________________________________
Name & Signature of Provincial Health Officer
Noted: _____________________________________
Name & Signature of Governor,
Provincial Nutrition Committee
____________________________________
Date
___________________________________
Date
Date
Series 2012
Page 2 of 4
Province ____________________

Total No. of Municipalities with OPT Plus Results _______

Please Check:
Municipality
(1)
Estimated No.
Total No of
of 0-71 mos old
0-71 mos old
Prev
PS
PS measured
(2)
(3)
(4)
0-5 months
Boys
Girls
(5)
(6)
6-11 months
Boys
Girls
(7)
(8)
12-23 months
Boys
Girls
(9)
(10)
24-35 months
Boys
Girls
(11)
(12)
36-47 months
Boys
Girls
(13)
(14)
48-59 months
Boys
Girls
(15)
(16)
60-71 months
Boys
Girls
(17)
(18)
TOTAL
Prepared by ___________________________________________
Approved ___________________________________________
Noted: _____________________________________
____________________________________
Date
___________________________________
Date
Date
Series 2012
Page 3 of 4
Province ____________________

Total No. of Municipalities with OPT Plus Results ________
Please Check:
Municipality
(1)
Estimated No.
Total No of
of 0-71 mos old
0-71 mos old
Prev
PS
PS measured
(2)
(3)
(4)
0-5 months
Boys
Girls
(5)
(6)

Sev. Stunted Length/Height-for-Age
6-11 months
Boys
Girls
(7)
(8)
12-23 months
Boys
Girls
(9)
(10)
24-35 months
Boys
Girls
(11)
(12)
36-47 months
Boys
Girls
(13)
(14)
48-59 months
Boys
Girls
(15)
(16)
60-71 months
Boys
Girls
(17)
(18)
TOTAL
Prepared by ___________________________________________
Approved ___________________________________________
Noted: _____________________________________
____________________________________
Date
___________________________________
Date
Date
Series 2012
Page 4 of 4
Province ____________________

Total No. of Municipalities with OPT Plus Results ___________

Please Check:
Municipality
(1)
Estimated No.
Total No of
of 0-71 mos old
0-71 mos old
Prev
PS
PS measured
(2)
(3)
(4)
0-5 months
Boys
Girls
(5)
(6)
6-11 months
Boys
Girls
(7)
(8)
12-23 months
Boys
Girls
(9)
(10)
24-35 months
Boys
Girls
(11)
(12)
36-47 months
Boys
Girls
(13)
(14)
48-59 months
Boys
Girls
(15)
(16)
60-71 months
Boys
Girls
(17)
(18)
TOTAL
Prepared by ___________________________________________
Approved ___________________________________________
Noted: _____________________________________
____________________________________
Date
___________________________________
Date
Date

OPT Plus Form 3A. Provincial Summary Report on Operation Timbang Plus
Province _______________________
Region _______________________
Total No. of Municipalities ________________________
Total No. of Barangays _________________________
Total No. of Municipalities with OPT Plus Results ______
Total No. of Barangays with OPT Plus Results __________
Percent OPT Coverage (Mun level) _______________
Percent OPT Coverage (Brgy level) ___________
Age
Group
Normal (N)
Underweight (UW)
Overweight (OW)
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
0-5
months
(R1)
6-11
months
(R2)
12-23
months
(R3)
24-35
months
(R4)
36-47
months
(R5)
48-59
months
(R6)
60-71
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos
Year _______
Indigenous Group: _______________________________
0-71 months old ___________
Estimated No of PS: 0-59 months old ___________ 0-71 months old: ___________
Actual No of PS measured: 0-59 months old ___________ 0-71 months old ____________
Total, by age group
TOTAL
Total N
Total UW
Total SUW
Total OW
Boys
Girls
Total
No
Prev
No
Prev
No
Prev
No
Prev
(18)
(19)
(20)
(21)
(22)
(23)
(24)
(25)
(26)
(27)
(28)
.

Prepared by: ________________________________________
Name & Signature of DNPC / Nutritionist
Date:
Validated: ______________________________________________
Name & Signature of Provincial Nutrition Action Officer
Date: ___________________________
Approved: __________________________________
Name & Signature of Governor
Chairperson, Province Nutrition Committee
Date:

Province _______________________
Region _______________________
Age
Group
Normal (N)
Stunted /Short (St)
Tall (T)
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
0-5
months
(R1)
6-11
months
(R2)
12-23
months
(R3)
24-35
months
(R4)
36-47
months
(R5)
48-59
months
(R6)
60-71
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos
Year _______
0-71 months old ___________
Total, by age group
TOTAL
Total N
Total St
Total SSt
Total T
Boys
Girls
Total
No
Prev
No
Prev
No
Prev
No
Prev
(18)
(19)
(20)
(21
(22)
(23)
(24)
(25)
(26)
(27)
(28)
.
Prepared by: ________________________________________

Date:
Validated: ______________________________________________
Date: ___________________________
Approved: __________________________________
Date:

Province _______________________
Age
Group
Normal (N)
Wasted (W)
Boys
Girls
Boys
Girls
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
0-5
months
(R1)
6-11
months
(R2)
12-23
months
(R3)
24-35
months
(R4)
36-47
months
(R5)
48-59
months
(R6)
60-71
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos
Region _______________________
Overweight (OW)
Boys
Girls
Boys
Girls
(10) (11) (12) (13) (14) (15) (16) (17)
Year _______
0-71 months old ___________
Total, by age group
Obese (Ob)
TOTAL
Total N
Total W
Total SW
Total OW
Boys
Girls
Boys Girls Total
No
Prev
No
Prev
No
Prev
No
Prev
(18) (19) (20) (21) (22)
(23)
(24)
(25)
(26)
(27)
(28)
(29)
(30)
(31)
(32)
Prepared by: ________________________________________

Date:
Validated: ______________________________________________
Date: ___________________________
Approved: __________________________________
Date:
Total Ob
No
Prev
(33)
(34)

OPT Plus Form 4. Regional Consolidation Sheet of Operation Timbang Plus Results
Series 2012
Page 1 of 4
Region ____________________
Please Check:
Province/City
(1)
Year _____________
Total No.: Province ______ City _______

Total No.with OPT Plus Results: Province _______City ______
Estimated No.
of 0-71 mos old
Total No of
0-71 mos old
PS
PS measured
(2)
(3)
Prev
%
0-5 months
Boys
Girls
(4)
(5)
6-11 months
Boys
Girls
(6)
(7)
12-23 months
Boys
Girls
(8)
(9)
24-35 months
Boys
Girls
(10)
(11)
36-47 months
Boys
Girls
(12)
(13)
48-59 months
Boys
Girls
(14)
(15)
TOTAL
Prepared by ____________________________________
Name & Signature of Nutrition Officer III
Approved ___________________________________________
Name & Signature of Nutrition Program Coordinator
Noted: _____________________________________
Name & Signature of Regional Director,
Chairperson, Regional Nutrition Committee
____________________________________
Date
___________________________________
Date
__________________________________
Date
60-71 months
Boys
Girls
(16)
(17)
Series 2012
Page 2 of 4
Region ____________________
Please Check:
Province/City
(1)
Period of Weighing _____________

Indigenous group & No of PS: ___________________

Estimated No.
of 0-71 mos old
Total No of
0-71 mos old
PS
PS measured
(2)
(3)
Prev
%
0-5 months
Boys
Girls
(4)
(5)
6-11 months
Boys
Girls
(6)
(7)
12-23 months
Boys
Girls
(8)
(9)
24-35 months
Boys
Girls
(10)
(11)
36-47 months
Boys
Girls
(12)
(13)
48-59 months
Boys
Girls
(14)
(15)
TOTAL
Prepared by ____________________________________
Approved ___________________________________________
Noted: _____________________________________
____________________________________
Date
___________________________________
Date
__________________________________
Date
60-71 months
Boys
Girls
(16)
(17)
Series 2012
Page 3 of 4
Region ____________________

Please Check:
Province/City
(1)
Estimated No.
of 0-71 mos old
Total No of
0-71 mos old
PS
PS measured
(2)
(3)
Prev
%
0-5 months
Boys
Girls
(4)
(5)
Sev. Stunted Length/Height-for-Age

6-11 months
Boys
Girls
(6)
(7)
12-23 months
Boys
Girls
(8)
(9)

24-35 months
Boys
Girls
(10)
(11)
36-47 months
Boys
Girls
(12)
(13)
48-59 months
Boys
Girls
(14)
(15)
TOTAL
Prepared by ____________________________________
Approved ___________________________________________
Noted: _____________________________________
____________________________________
Date
___________________________________
Date
__________________________________
Date
60-71 months
Boys
Girls
(16)
(17)
Series 2012
Page 4 of 4
Region ____________________

Please Check:
Province/City
(1)
Estimated No.
of 0-71 mos old
Total No of
0-71 mos old
PS
PS measured
(2)
(3)
Prev
%
0-5 months
Boys
Girls
(4)
(5)
6-11 months
Boys
Girls
(6)
(7)
12-23 months
Boys
Girls
(8)
(9)

24-35 months
Boys
Girls
(10)
(11)
36-47 months
Boys
Girls
(12)
(13)
48-59 months
Boys
Girls
(14)
(15)
TOTAL
Prepared by ____________________________________
Approved ___________________________________________
Noted: _____________________________________
____________________________________
Date
___________________________________
Date
__________________________________
Date
60-71 months
Boys
Girls
(16)
(17)

OPT Plus Form 4B. Report on Regional Coverage of Operation Timbang Plus
Series 2012
Region _______________________________
Period of OPT_____________________
Province/City
Total Number of
Municipalities
Number of Municipalities
with OPT Results
Total Number of
Barangays
Number of Barangays
with OPT Results
(1)
(2)
(3)
(4)
(5)
Prepared by: _______________________________________

Nutrition Officer III, NNC-Reg __
Validated by: __________________________________________

Nutrition Program Coordinator, NNC-Reg __
Estimated Number of
Preschoolers
Aged 0-71 months
(6)
Actual Number of
Preschoolers Measured
(7)
Actual Number of
Indigenous
Preschoolers Measured
(8)
Date __________________________

OPT Plus Form 4A. Regional Summary Report on Operation Timbang Plus
Region _______________________
Total No. of Province ____ City ____
Total No. with OPT Plus Results: Province ____ City _____
Percent OPT Coverage Province _____ City _____
Age
Group
(1)
0-5
months
(R1)
6-11
months
(R2)
12-23
months
(R3)
24-35
months
(R4)
36-47
months
(R5)
48-59
months
(R6)
60-71
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos
Normal (N)
Boys
Girls
(2)
(3)
(4)
(5)
Indigenous Group/s: _________________________________

Total No. of Municipalities______ Barangay ______
Total No. with OPT Plus Results: Mun _____ Brgy _____
Percent OPT Coverage Mun _____ Brgy ______
Underweight (UW)
Boys
Girls
(6)
(7)
(8)
(9)

Boys
Girls
(10)
(11)
(12)
(13)
Year _______
Previous Year Prevalence Rate: ______
0-71 months old __________
Estimated No of PS: 0-59 months old _________ 0-71 months old: ________
Actual No of PS measured: 0-59 months old _________ 0-71 months old _________
Total, by age group
Overweight (OW)
TOTAL
Total N
Total UW
Total SUW
Total OW
Boys
Girls
Boys
Girls
Total
No
Prev
No
Prev
No
Prev
No
Prev
(14)
(15)
(16)
(17)
(18)
(19)
(20)
(21)
(22)
(23)
(24)
(25)
(26)
(27)
(28)
.

Prepared by: ________________________________________
Date:
Validated by: ______________________________________________

Name & Signature of Nutrition Programme Coordinator
Date: ___________________________
Approved by: __________________________________

Name & Signature of Director
Date:

Region _______________________
Age
Group
(1)
0-5
months
(R1)
6-11
months
(R2)
12-23
months
(R3)
24-35
months
(R4)
36-47
months
(R5)
48-59
months
(R6)
60-71
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos
Normal (N)
Boys
Girls
(2)
(3)
(4)
(5)
Indigenous Group: ___________________________________

Stunted /Short (St)

Boys
Girls
(6)
(7)
(8)
(9)

Boys
Girls
(10)
(11)
(12)
(13)
Year _______
0-71 months old __________
Total, by age group
Tall (T)
TOTAL
Total N
Total St
Total SSt
Total T
Boys
Girls
Boys
Girls
Total
No
Prev
No
Prev
No
Prev
No
Prev
(14)
(15)
(16)
(17)
(18)
(19)
(20)
(21
(22)
(23)
(24)
(25)
(26)
(27)
(28)
.
Prepared by: ________________________________________

Date:
Validated by: ______________________________________________

Date: ___________________________
Approved by: __________________________________

Date:

Region _______________________
Age
Group
(1)
0-5
months
(R1)
6-11
months
(R2)
12-23
months
(R3)
24-35
months
(R4)
36-47
months
(R5)
48-59
months
(R6)
60-71
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos
Normal (N)
Boys
Girls
(2)
(3)
(4)
(5)
Indigenous Group: ___________________________________

Wasted (W)
Boys
Girls
(6)
(7)
(8)
(9)
Year _______
0-71 months old __________
Total, by age group
Overweight (OW)
Obese (Ob)
TOTAL
Total N
Total SW
Total SW
Total OW
Boys
Girls
Boys
Girls
Boys
Girls
Boys Girls Total No Prev No Prev No Prev No Prev
(10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22)
(23)
(24)
(25) (26) (27) (28) (29) (30) (31) (32)
Total Ob
No Prev
(33) (34)
Prepared by: ________________________________________

Date:
Validated by: ______________________________________________

Date: ___________________________
Approved by: __________________________________

Date: ______________________

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Republic of the Philippines

Name of Household Head/

* Codes: for nutritional status:

SUW- Severely Underweight

Date of OPT Plus: __________

Prepared By: _____________________________________________

Republic of the Philippines

Name of Household Head/

* Codes: for nutritional status:

SUW- Severely Underweight

Date of OPT Plus: __________

Prepared By: _____________________________________________

Republic of the Philippines

Note: a) R1 means Row No. 1, R2 means Row 2, etc.

d) Prev (C21,23,25,27)- refers to the prevalence rate by total by age group

Year/Period of Measurement _________ CY20__ Prev*: _______

Total, by age group

* refers to previous year prevalence rate of the area

OVERWEIGHT IS MORE CORRECTLY DETERMINED USING WEIGHT-FOR-LENGTH OR WEIGHT-FOR-HEIGHT.

Republic of the Philippines

Note: a) R1 means Row No. 1, R2 means Row 2, etc.

d) Prev (C21,23,25,27)- refers to the prevalence rate by total by age group

Prepared by: ________________________________________

Year/Period of Measurement _________ CY20__ Prev*: _______

Total, by age group

* refers to previous year prevalence rate of the area

Republic of the Philippines

Note: a) R1 means Row No. 1, R2 means Row 2, etc.

d) Prev (C21,23,25,27)- refers to the prevalence rate by total by age group

Prepared by: ________________________________________

* refers to previous year prevalence rate of the area

Republic of the Philippines

In column 5, write "NA" if not applicable, specify specific indegenous group/tribe.

Name of Household Head/

Prepared by: ______________________________________

Name & Signature of Barangay Nutrition Scholar

Name & Signature of Barangay Captain,

Name & Signature of Midwife/Nurse/District/City Nutrition Program Coordinator

Republic of the Philippines

Total No. of Barangays 20

Year/Period of Measurement 2014

Total No. of Barangays 20

Total Number of Children

Year/Period of Measurement 2014

Total No. of Barangays 20

Total Number of Children

Year/Period of Measurement 2014

Total Number of Children

Year/Period of Measurement 2014

Total Number of Children

Total No. of Barangays 20

DRA. GIRANY A. FARIAS

Name & Signature of DCNPC/Nutritionist/C/MNAO

Name & Signature of City/Municipal Health Officer

EDUARDO RAMOS TIBAY

DRA. GIRANY A. FARIAS

Name & Signature of DCNPC/Nutritionist/C/MNAO

Name & Signature of City/Municipal Health Officer

City/Municipal Nutrition Committee

EDUARDO RAMOS TIBAY

DRA. GIRANY A. FARIAS

Name & Signature of DCNPC/Nutritionist/C/MNAO

Name & Signature of City/Municipal Health Officer

Year/Period of Measurement _ CY20 Prev*: _

Year/Period of Measurement _ CY20 Prev*: _

Total No.: Province City _

Total No.: Province City _

Total No.: Province City _

Total No.: Province City _