OPT Plus Masterlist Form - Updated - Feb 2021

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Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL

OPT Plus Form 1. List of 0-59 months old Preschoolers with Weight, Length/Height and MUAC Measurements, and Identified Nutritional Status
Revised February 2021
Barangay: __________________________________ City/Municipality: ____________________________ Province: ___________________________________ Region: _____ Year: _________

Date of Date of Age in Measurement Bilateral Nutritional Status*


Seq. Household Name of Mother Name of Preschooler IP 4Ps Sex Pitting
Current Purok Birth Measurement Months Weight Length/ MUAC Edema MUAC Weight for Length/Height Weight for
OPT Number (Surname, First Name & Middle Initial) (Surname, First Name & Middle Initial) Height
(Y/N) (Y/N) (M/F) (MM/DD/YYYY) (MM/DD/YYYY) (kg) (cm) (Y/N) Status Age for Age Length/Height

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19)

(11)/"Age-in-months" refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. If the child is day/s old or less than 1 month old, put 0.

Note: Use WEIGHT-FOR-LENGTH for 0-23months old preschool children and WEIGHT-FOR-HEIGHT for 24-59 months old preschool children
Use WEIGHT-FOR-LENGTH or WEIGHT-FOR-HEIGHT to correctly determine overweight and obesity.

Prepared by: Checked & Verified: Attested: Noted:

___________________________________________ ___________________________________________ _________________________________________ _____________________________________________


Name and Signature of Barangay Nutrition Scholar Name and Signature of Public Health Midwife Name and Signature of BNC/Barangay Chairman Name and Signature of City/Municipal Nutrition Action Officer
Date: _____________________ Date: _____________________ Date: _____________________ Date: _____________________
Republic of the Philippines
Department of Health
NATIONAL NUTRITION COUNCIL

OPT Plus Form 1B. List of Malnourished/Nutritionally-At-Risk Preschoolers 0-59 Months Old
Revised February 2021

Barangay: _____________________________________ Province: _______________________________ Period of Measurement Covered :


City/Municipality: ______________________________ Region: _______ ___________________________________

NUTRITIONAL STATUS
Seq. Household Name of Mother Name of Preschooler Sex Indigenous (IP)/ Age in
Purok WFA L/HFA WFL/H MUAC Status
No. Number (Surname, First Name & Middle Initial) (Surname, First Name & Middle Initial) (M/F) Ethnic Group months
UW SUW St SSt W SW OW Ob SAM MAM Edema
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19)

TOTAL

Prepared by: Checked and Verified: Attested: Noted:

_____________________________________________________ __________________________________________________ ________________________________________ ___________________________________________


Name and Signature of Barangay Nutrition Scholar Name and Signature of Public Health Midwife Name and Signature of BNC/Barangay Chairman Name & Signature of City/Mun. Nutrition Action Officer
Date: _____________________ Date: _____________________ Date: _____________________ Date: _____________________

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