SEX Tgl Timbang Tgl Lahir NILAI Z_SCORE STATUS GIZI PENANGANAN PENYEBAB NO NAMA BARU/L Umur BB TB NAMA ORANG TUA ALAMAT PMT/RECOVIT/P BBLR/SAKIT/LA GAKIN / KETERANGAN AMA L=1, P=2 Tgl Bln Thn Tgl Bln Thn (Bln (Kg) (Cm) BB/U TB/U BB/TB BB/TB BB/U TB/U BB/TB MT+RECOVIT IN-LAIN NON GAKIN JENIS PMT