OPT Forms Series NG Divine

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 February2012
Barangay: City/Municipality: ____________ Province: __________________ Year: ______ Date of OPT Plus: __________
Household Name of Household Head/ Date of (Yr-Mo-Day) Age in Weight Length/ Nutritional Status*
Purok Number Mother/Caregiver Name of Preschooler Sex Birthday Measurement Months (kg) Height Weight for Length/ Weight for
Weight Length/Height (cm) Age Ht for Age Length/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
1/
"Age-in-months" refers to completed number of months. For instance, 34 months and 30 days is considered 34 months only. overweight and obesity.
Prepared By: _____________________________________________ Checked: __________________________________________________________

Name and Signature of Barangay Nutrition Scholar Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator
Date: __________________________ Date: __________________________
OPT Plus Form 1A. Barangay Tally and Summary Sheet of Preschoolers with Weight & Height Measurement by Age Group, Sex and Nutritional Status
Revised February 2012 Page 1 of 3
Barangay: ____________________________ Estimated Number of Preschoolers: 0-59 months old1/ _________ 0-71 months old2/__________ CY20 _____Total Population of Barangay: ______________ Source ____________
City/Municipality: _____________________ Actual Number of Preschoolers Weighed: 0-59 months old __________ 0-71 months old __________ Year/Period of Measurement :_________
Province: ____________________________ Percent OPT Plus Coverage: 0-59 months old __________ 0-71 months old __________ CY 20______ Prevalence Rate UW & SUW 3/ ___________
Region: ______________ Number of Indigenous PS measured: 0-59 months old __________ 0-71 months old __________ Prev Rate of UW & SUW: 0-59 mos old _______ 0-71 mos old _________
Indigenous group (specify if applicable): __________________
Age Weight for Age Status Total, by age group
Group Normal (N) Underweight (UW) Severely Underweight (SUW) Overweight (OW) TOTAL N UW SUW OW
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)
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
Note: a) R1 means Row No. 1, R2 means Row 2, etc. b)Total (R8) - refers to the sum of preschoolers by nutritional status and by age group c) Prev (R9)- refers to the prevalence rate by sex, by nutritional status for age group 0- 59 months and 0- 71 months
d) Prev (C22,24,26,28)- refers to the prevalence rate by total by age group 1/ 0-59 months = 13.5 x Total Population 2/ 0-71 months = 16.2 x Total Population 3/ Refers to previous year prevalence rate of the area
Use WEIGHT-FOR-LENGTH or WEIGHT-FOR-HEIGHT to correctly determine overweight and obesity
Prepared by: __________________________________________ Checked: ___________________________________________ Approved: ____________________________________

Name and Signature of Barangay Nutrition Scholar Name and Signature of Midwife/Nurse/ Name and Signature of Barangay Captain,
District/City Nutrition Program Coordinator BNC Chairperson
Date: _____________________ Date: _____________________ Date: _____________________
City/Municipality: _____________________ Actual Number of Preschoolers Weighed: 0-59 months old __________ 0-71 months old __________ Year/Period of Measurement: _________
Region: ______________ Number of Indigenous PS measured: 0-59 months old __________ 0-71 months old __________ Prevalence Rate St & SSt: 0-59 mos old _______ 0-71 mos old _______
Age Length/Height for Age Status Total, by age group
Group Normal (N) Stunted /Short (St) Severely Stunted (SSt) Tall (T) TOTAL N St SSt T
(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)
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
Prepared by: __________________________________________ Checked: ___________________________________________ Approved: ____________________________________

Name and Signature of Barangay Nutrition Scholar Name and Signature of Midwife/Nurse/ Name and Signature of Barangay Captain,
Date: _____________________ Date: _____________________ Date: _____________________
City/Municipality: _____________________ Actual Number of Preschoolers Weighed: 0-59 months old __________ 0-71 months old __________ Year/Period of Measurement: _________
Region: ______________ Number of Indigenous PS measured: 0-59 months old __________ 0-71 months old __________ Prevalence Rate W & SW: 0-59 mos old _______ 0-71 mos old ______
Age Weight for Length/Height Status Total, by age group
Group Normal (N) Wasted (W) Severely Wasted (SW) Overweight (OW) Obese (Ob) TOTAL N W SW OW Ob
Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Total No Prev 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) (33) (34)
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
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos
Use WEIGHT-FOR-LENGTH for 0-23 months old preschool children and WEIGHT-FOR-HEIGHT for 24-60 months old preschool children.
Prepared by: ________________________________________ Checked: ___________________________________________ Approved: ____________________________________

Name & Signature of Barangay Nutrition Scholar Name & Signature of Midwife/Nurse/ Name & Signature of Barangay Captain,
Date: _____________________ Date: _____________________ Date: _____________________
OPT Plus Form 1B. List of Affected/At-risk Preschoolers 0-71 Months old
Revised February 2012
Barangay: ___________________________________ Province: ________________________________

City/Municipality: _____________________________ Year/Period of Measurement _____________
Instructions:
In column 1, copy the household number from the Family Profile. In column 5, specify if household members belong to an indigenous people group; write "NA" if not applicable
In column2, write the family name first, followed by name of the household head. In column 6, indicate the age in months based on last completed month.
In column 3, write the first name of the preschool child. In column 7-14, check the appropriate nutritional status.
In column 4, write "B" for boy and "G" for girl. For the TOTAL row, add all the values in each column.
Household Name of Household Head/ Name of Preschooler Sex Indigenous Age in Nutritional Status
Number Mother/Caregiver Group months UW SUW St SSt W SW OW Ob
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)
TOTAL
Prepared by: ______________________________ Checked: ___________________________________________ Approved: _________________________________

Name and Signature of Barangay Nutrition Name and Signature of Midwife/Nurse/District/City Nutrition Program Coordinator Name and Signature of Barangay Captain,
Date _________________________ Date _________________________ BNC Chairperson
Date _________________________
Page 5 of 27
OPT Plus Form 2. City/Municipal Consolidation Sheet of Operation Timbang Plus Results
City/Municipality ________________ Total No. of Barangays _________________________ Year/Period of Measurement _____________

Province _______________________ Total No. of Barangays with OPT Plus Results ___________ Indigenous Group/s: ___________________
Number of Indigenous PS measured: 0-59 mos old ______ 0-71 mos old _______
Please check: Normal Weight-for-Age Normal Length/Height-for-Age Normal Weight-for-Length/Height
Total Number of Children
Estimated No. of Total No of
Barangay 0-71 mos old 0-71 mos old PS
Coverage 0-5 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months 60-71 months
Preschool children measured % Boys Girls Boys Girls Boys Girls 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) (18)
TOTAL
Prepared by ___________________________________________ Approved ___________________________________________ Noted: _____________________________________

Name and Signature of DCNPC/Nutritionist/C/MNAO Name and Signature of City/Municipal Health Officer Name and Signature of Mayor,
City/Municipal Nutrition Committee
Date __________________________________ Date __________________________________ Date __________________________________


Province _______________________ Total No. of Barangays with OPT Results __________ Indigenous Group/s: ___________________
Please Check: Underweight Weight-for-Age Stunted Length/Height-for-Age Wasted Weight-for-Length/Height
Barangay 0-71 mos old 0-71 mos old PS
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)
TOTAL

Date __________________________________ Date __________________________________ Date __________________________________

City/Municipality ________________ Total No. of Barangays ___________________ Year/Period of Measurement _____________

Province _______________________ Total No. of Barangays with OPT Results _____ Indigenous Group/s: ___________________
Please check: Sev. UW Weight-for-Age Sev. Stunted Length/Height-for-Age Sev. Wasted Weight-for-Length/Height
Barangay
0-71 mos old 0-71 mos old PS
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)
TOTAL

Date __________________________________ Date __________________________________ Date __________________________________


Province _______________________ Total No. of Barangays with OPT Results ___________ Indigenous Group/s: ___________________
Please check: Overweight Weight-for-Age Tall Length/Height-for-Age Overweight Weight-for-Length 1//Height2/ Obese Weight-for-Length1//Height2/
Barangay Total Number of Children
Estimated No. of Total No of Coverage 0-5 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months 60-71 months
0-71 mos old 0-71 mos old PS
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)
TOTAL
1/ Use WEIGHT-FOR-LENGTH for 0-23 months old preschool children
2/ Use WEIGHT-FOR-HEIGHT for 24-60 months old preschool children
Date __________________________________ Date __________________________________ Date __________________________________

OPT Plus Form 2A. City/Municipality Summary Report on Operation Timbang Plus
City/Municipality: _____________________ Total Population of City/Municipality : _____________ Source ________ Estimated No. of PS: 0-59 months old2/_______ 0-71 months old3/_______
Province: ____________________________ Year/Period of Measurement _____________ Actual No. of PS measured: 0-59 months old ________ 0-71 months old _______
1/
Region: _____________________________ CY 20______ Prevalence Rate UW & SUW : ____________ Percent OPT Plus Coverage: 0-59 months old ________ 0-71 months old _______
Total No of Barangays: __________ Prevalence Rate of UW & SUW: 0-59 mos old _____ 0-71 mos old _____ No. of Indigenous PS measured: 0-59 months old ________ 0-71 months old _______
Total No of Barangays w/ OPT Plus results/Percent Coverage: ______________ Indigenous Group/s: (Please specify)
Group Normal (N) Underweight (UW) Sev Underweight (SUW) Overweight (OW) TOTAL Total N Total UW Total SUW Total OW
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20)
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
d) Prev (C22,24,26,28)- refers to the prevalence rate by total by age group 1/ Refers to previous year prevalence rate of the area 2/ 0-59 months = 13.5 x Total Population 3/ 0-71 months = 16.2 x Total Population
d) Prev (C22,24,26,28)- refers to the prevalence rate by total by age group 1/ Refers to previous year prevalence rate of the area 2/ 0-59 months = 13.5 x Total Population 3/ 0-71 months = 16.2 x Tota
Prepared by: __________________________________________________ Checked: ___________________________________________ Approved: ____________________________________
Name and Signature of DCNPC/Nutritionist /C/MNAO Name and Signature of City/Municipal Health Officer Name and Signature of Mayor,
Date: ______________________ Date: ______________________ Date: ______________________
Page 2 of 3
City/Municipality: _____________________ Total Population of City/Municipality : __________________ Estimated No. of PS: 0-59 months old2/_______ 0-71 months old3/_______
1/
Region: ____________________________ CY 20______ Prevalence Rate UW & SUW : ___________ Percent OPT Plus Coverage: 0-59 months old ________ 0-71 months old _______
Total No of Barangays: _______ Prevalence Rate of St & SSt: 0-59 mos old _______ 0-71 mos old _______ No. of Indigenous PS measured: 0-59 months old ________ 0-71 months old _______
Age Length/Height for Age Status Total, by age group
Group Normal (N) Stunted /Short (St) Sev Stunted (SSt) Tall (T) TOTAL Total N Total St Total SSt Total T
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20)
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
ation 3/ 0-71 months = 16.2 x Total Population

Date: ______________________ Date: ______________________ Date: ______________________
Page 3 of 3
City/Municipality: _____________________ Total Population of City/Municipality : __________________ Estimated No. of PS: 0-59 months old2/_______ 0-71 months old3/_______
1/
Region: ____________________________ CY 20______ Prevalence Rate UW & SUW : ___________ Percent OPT Plus Coverage: 0-59 months old ________ 0-71 months old _______
Total No of Barangays: _______ Prevalence Rate of W & SW: 0-59 mos old _______ 0-71 mos old ____ No. of Indigenous PS measured: 0-59 months old ________ 0-71 months old _______
Age Weight for Length/Height Status Total, by age group
Group Normal (N) Wasted (W) Severely Wasted (SW) Overweight (OW) Obese (Ob) TOTAL Total N Total W Total SW Total OW Total Ob
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)
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
months
(R7)
Total (R8)
0-59 mos
0-71 mos
Prev (R9)
0-59 mos
0-71 mos

Date: ______________________ Date: ______________________ Date: ______________________
OPT Plus Form 3. Provincial Consolidation Sheet of Operation Timbang Plus Results
Province ____________________ Total No. of Municipalities _________________________ Year/Period of Measurement _____________

Total No. of Municipalities with OPT Plus Results ___________ Indigenous Group/s: ___________________
Please Check: Normal Weight-for-Age Normal Length/Height-for-Age Normal Weight-for-Length/Height
Estimated No. Total No of Total Number of Children
Municipality of 0-71 mos old 0-71 mos old Coverage 0-5 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months 60-71 months
PS PS measured % Boys Girls Boys Girls Boys Girls 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) (18)
Dumalag 4983 4325 87% 115 115 95 90 293 252 321 280 321 281 380 400 640 621
TOTAL 4983 4325 1 115 115 95 90 293 252 321 280 321 281 380 400 640 621

Name and Signature of DCNPC/Nutritionist/PNAO Name and Signature of Provincial Health Officer Name and Signature of Governor,
Provincial Nutrition Committee
Date _____________________________________ Date _____________________________________ Date _____________________________________
OPT Plus Form 3. Provincial Consolidation Sheet of Operation Timbang Plus Results OPT Plus Form
Revised February 2012 Page 2 of 4 Revised February 2012 P
Province ____________________ Total No. of Municipalities _________________________ Year/Period of Measurement _____________ Province ______
Total No. of Municipalities with OPT Plus Results _______ Indigenous Group/s: ___________________
Please Check: Number of Indigenous PS measured: 0-59 mos old ______ 0-71 mos old _______ Please Check:
Underweight Weight-for-Age Stunted Length/Height-for-Age Wasted Weight-for-Length/Height
Municipality of 0-71 mos old 0-71 mos old Coverage 0-5 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months 60-71 months Municipality
PS PS measured % Boys Girls Boys Girls Boys Girls 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) (18) (1)
Dumalag 4983 4325 87% 0 0 6 0 7 6 10 8 2 5 0 5 6 6 Dumalag
TOTAL TOTAL
Prepared by ___________________________________________ Approved ___________________________________________ Noted: _____________________________________ Prepared by _______

Name and Signature of DCNPC/Nutritionist/PNAO Name and Signature of Provincial Health Officer Name and Signature of Governor, Name a
Date _____________________________________ Date _____________________________________ Date _____________________________________ Date ____________
orm 3. Provincial Consolidation Sheet of Operation Timbang Plus Results OPT Plus Form 3. Provincial Co
012 Page 3 of 4 Revised February 2012 Page 4 of 4
_________________ Total No. of Municipalities _________________________ Year/Period of Measurement _____________ Province ____________________
Total No. of Municipalities with OPT Plus Results ________ Indigenous Group/s: ___________________
Sev. UW Weight-for-Age Sev. Stunted Length/Height-for-Age Sev. Wasted Weight-for-Length/Height Please check:
Estimated No. Total No of Total Number of Children Estimated No.
of 0-71 mos old 0-71 mos old Coverage 0-5 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months 60-71 months Municipality of 0-71 mos old
PS PS measured % Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls PS
(2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (1) (2)
4983 4325 87% 0 0 0 1 1 2 0 0 1 1 1 0 1 0 Dumalag 4983
TOTAL
1/ Use WEIGHT-FOR-LEN
2/ Use WEIGHT-FOR-HEI
________________________________________ Approved ___________________________________________ Noted: _____________________________________ Prepared by ________________________

ame and Signature of DCNPC/Nutritionist/PNAO Name and Signature of Provincial Health Officer Name and Signature of Governor, Name and Signature of DCN
_____________________________ Date _____________________________________ Date _____________________________________
Date ______________________________
Plus Form 3. Provincial Consolidation Sheet of Operation Timbang Plus Results
nce ____________________ Total No. of Municipalities _________________________ Year/Period of Measurement _____________

Total No. of Municipalities with OPT Plus Results ___________ Indigenous Group/s: ___________________
e check: Overweight Weight-for-Age Tall Length/Height-for-Age Overweight Weight-for-Length 1//Height2/ Obese Weight-for-Length1//Height2/
Total No of Total Number of Children
0-71 mos old Coverage 0-5 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months 60-71 months
PS measured % Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls
(3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)
4325 87% 0 0 3 2 6 5 4 5 4 5 5 7 1 5
Use WEIGHT-FOR-LENGTH for 0-23 months old preschool children

Use WEIGHT-FOR-HEIGHT for 24-60 months old preschool children
d by ___________________________________________ Approved ___________________________________________ Noted: _____________________________________

Name and Signature of DCNPC/Nutritionist/PNAO Name and Signature of Provincial Health Officer Name and Signature of Governor,
____________________________________ Date _____________________________________ Date _____________________________________

OPT Plus Form 3A. Provincial Summary Report on Operation Timbang Plus
Page 1 of 3
Region: _____________________ Total Population of Province/Source: ______________________________

Province: _______________________ Year/Period of Measurement _______________ Estimated No. of PS: 0-59 months old2/_________ 0-71 months old3/________
Total No. of Municipalities _______ Mun w/ OPT Plus Results _______ Percent OPT Plus Coverage (Mun level) _______ Actual No of PS measured: 0-59 months old __________ 0-71 months old ________
Total No. of Barangays _______ Bgys w/ OPT Plus Results ________ Percent OPT Plus Coverage (Brgy level) _______ Percent OPT Plus Coverage: 0-59 months old __________ 0-71 months old ________
CY 20______ Prevalence Rate UW & SUW1/: ___________ Total Population of Province: ______________ No. of Indigenous PS measured: 0-59 months old __________ 0-71 months old ________
Prevalence Rate of UW & SUW: 0-59 months old ______ 0-71 months old ________ Indigenous Group: (Please specify)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20)
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
Prepared by: ___________________________________________ Checked: ___________________________________________ Approved: __________________________________

Name and Signature of DCNPC/Nutritionist Name and Signature of Provincial Health Officer Name and Signature of Governor
Chairperson, Province Nutrition Committee
Date: Date: Date:
OPT Plus Form 3A. Provincial Summary Report on Operation Timbang Plus OPT Plus Form 3A. Prov
Revised February 2012 Page 2 of 3 Revised February 2012
Region: _____________________ Total Population of Province/Source: ______________________________ Region: ______________

Province: _______________________ Year/Period of Measurement _______________ Estimated No. of PS: 0-59 months old2/_________ 0-71 months old3/________ Province: ____________
Total No. of Municipalities _______ Mun w/ OPT Plus Results _______ Percent OPT Plus Coverage (Mun level) _______ Actual No of PS measured: 0-59 months old __________ 0-71 months old ________ Total No. of Municipalitie
Total No. of Barangays _______ Bgys w/ OPT Plus Results ________ Percent OPT Plus Coverage (Brgy level) _______ Percent OPT Plus Coverage: 0-59 months old __________ 0-71 months old ________ Total No. of Barangays _
CY 20______ Prevalence Rate UW & SUW1/: ___________ Total Population of Province: ______________ No. of Indigenous PS measured: 0-59 months old __________ 0-71 months old ________ CY 20______ Prevalence
Prevalence Rate of St & SSt: 0-59 months old _______ 0-71 months old _________ Indigenous Group: (Please specify) Prevalence Rate of W & S
Age Length/Height for Age Status Total, by age group Age
Group Normal (N) Stunted /Short (St) Severely Stunted (SSt) Tall (T) TOTAL Total N Total St Total SSt Total T Group
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (1)
0-5 . 0-5
months months
(R1) (R1)
6-11 6-11
months months
(R2) (R2)
12-23 12-23
months months
(R3) (R3)
24-35 24-35
months months
(R4) (R4)
36-47 36-47
months months
(R5) (R5)
48-59 48-59
months months
(R6) (R6)
60-71 60
months months
(R7) (R7)
Total (R8) Total (R8)
0-59 mos 0-59 mos
0-71 mos 0-71 mos
Prev (R9) Prev (R9)
0-59 mos 0-59 mos
0-71 mos 0-71 mos
Note: a) R1 means Row No. 1, R2 means Row 2, etc. b)Total (R8) - refers to the sum of preschoolers by nutritional status and by age group c) Prev (R9)- refers to the prevalence rate by sex, by nutritional status for age group 0- 59 months and 0- 71 months Note: a) R1 means Row No.
d) Prev (C22,24,26,28)- refers to the prevalence rate by total by age group 1/ Refers to previous year prevalence rate of the area 2/ 0-59 months = 13.5 x Total Population 3/ 0-71 months = 16.2 x Total Population d) Prev (C22,24,26,28
Use WEIGHT-FOR-LE
Use WEIGHT-FOR-LE
Prepared by: ___________________________________________ Checked: ___________________________________________ Approved: __________________________________ Prepared by: __________
Date: Date: Date: Date:
OPT Plus Form 3A. Provincial Summary Report on Operation Timbang Plus
Region: _____________________ Total Population of Province/Source: ______________________________

Province: _______________________ Year/Period of Measurement _______________ Estimated No. of PS: 0-59 months old2/____________ 0-71 months old3/____________
Total No. of Municipalities _______ Mun w/ OPT Plus Results _______ Percent OPT Plus Coverage (Mun level) _______ Actual No of PS measured: 0-59 months old _____________ 0-71 months old _____________
Total No. of Barangays _______ Bgys w/ OPT Plus Results ________ Percent OPT Plus Coverage (Brgy level) _______ Percent OPT Plus Coverage: 0-59 months old _____________ 0-71 months old _____________
CY 20______ Prevalence Rate UW & SUW1/: ___________ Total Population of Province: ______________ No. of Indigenous PS measured0-59 months old _____________ 0-71 months old _____________
Prevalence Rate of W & SW: 0-59 months old _______ 0-71 months old _________ Indigenous Group: (Please specify)
Weight for Length/Height Status Total, by age group
Normal (N) Wasted (W) Severely Wasted (SW)Overweight (OW) Obese (Ob) TOTAL Total N Total W Total SW Total OW Total Ob
(2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)
Prepared by: ___________________________________________ Checked: ___________________________________________ Approved: __________________________________

Date: Date:
OPT Plus Form 4. Regional Consolidation Sheet of Operation Timbang Plus Results
Region ____________________ Total No.: Province ______ City _______ Year _____________
Total No.with OPT Plus Results: Province _______City ______ Indigenous Group/s: ___________________
Please Check: Normal Weight-for-Age Normal Length/Height-for-Age Normal Weight-for-Length/Height
Province/City of 0-71 mos old 0-71 mos old Coverage 0-5 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months 60-71 months
PS PS measured Boys Girls Boys Girls Boys Girls 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)
TOTAL
Prepared by ____________________________________ Approved _________________________________________________ Noted: _____________________________________

Name and Signature of Nutrition Officer III Name and Signature of Nutrition Program Coordinator Name and Signature of Regional Director,
Chairperson, Regional Nutrition Committee
Date ____________________________________ Date ____________________________________ Date ____________________________________
Region ____________________ Total No.: Province ______ City _______ Period of Weighing _____________
Total No.with OPT Plus Results: Province _______City ______ Indigenous group & No of PS: ___________________
Please Check: Number of Indigenous PS measured: 0-59 mos old ______ 0-71 mos old _______
Underweight Weight-for-Age Stunted Length/Height-for-Age Wasted Weight-for-Length/Height
%
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17)
TOTAL

Date ____________________________________ Date ____________________________________ Date ____________________________________
Please Check: Number of Indigenous PS measured: 0-59 mos old ______ 0-71 mos old _______
Sev. UW Weight-for-Age Sev. Stunted Length/Height-for-Age Sev. Wasted Weight-for-Length/Height
%
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17)
TOTAL

Date ____________________________________ Date ____________________________________ Date ____________________________________
Please check: Overweight Weight-for-Age Tall Length/Height-for-Age Overweight Weight-for-Length 1//Height2/ Obese Weight-for-Length 1//Height2/
%
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17)
TOTAL
1/ Use WEIGHT-FOR-LENGTH for 0-23 months old preschool children
2/ Use WEIGHT-FOR-HEIGHT for 24-60 months old preschool children

Date ____________________________________ Date ____________________________________ Date ____________________________________
OPT Plus Form 4B. Report on Regional Coverage of Operation Timbang Plus
Region _____________________Total Population/Source___________________________________ CY20_______ Prevalence Rate Weight-for-Age _________
Year/Period of Measurement____ No. of Indigenous Group/s measured_________________________ Prevalence Rate Weight/Age _______Length-Height/Age _______ Weight/Length-Height ________
Total Number of Number of Municipalities Total Number of Number of Barangays Estimated Number of Actual Number of Actual No. of
Province/City Municipalities with OPT Results Barangays with OPT Results Preschoolers Preschoolers Indigenous PS
Aged 0-71 months Weight Height Weight Height
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Prepared by: _____________________________________ Validated by: __________________________________________ Date __________________________

Nutrition Officer III, NNC-Reg __ Nutrition Program Coordinator, NNC-Reg __
OPT Plus Form 4A. Regional Summary Report on Operation Timbang Plus
Region _______________________ Year/Period of Measurement _________________________ Estimated No. of PS: 0-59 months old2/_________ 0-71 months old3/_________
Total No. of Prov _____ City _____ Mun _____ Total Population of Region/Source ____________________ Actual No of PS measured: 0-59 months old _________ 0-71 months old _________
Total No. with OPT Plus Results: Prov _____ City _____ Mun _____ Indigenous Group: (Please specify) Percent OPT Plus Coverage: 0-59 months old _________ 0-71 months old _________
Percent OPT Plus Coverage: Prov _____ City _____ Mun _____ _______________________________________________ No. of Indigenous PS measured: 0-59 months old _________ 0-71 months old _________
CY 20______ Prevalence Rate UW & SUW1/: ___________ _______________________________________________ Prevalence Rate of UW & SUW: 0-59 months old _________ 0-71 months old _________
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20)
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
Prepared by: ________________________________________ Validated by: ______________________________________________ Approved by: __________________________________

Name and Signature of Nutrition Officer III Name and Signature of Nutrition Programme Coordinator Name and Signature of Director
Date: ___________________________ Date: ___________________________ Date: ___________________________
OPT Plus Form 4A. Regional Summary Report on Operation Timbang Plus OPT Plus Form 4A. Regional Summary
Revised February 2012 Page 2 of 3 Revised February 2012
Region _______________________ Year/Period of Measurement _________________________ Estimated No. of PS: 0-59 months old2/_________ 0-71 months old3/_________ Region _______________________
Total No. of Prov _____ City _____ Mun _____ Total Population of Region/Source ____________________ Actual No of PS measured: 0-59 months old _________ 0-71 months old _________ Total No. of
Total No. with OPT Plus Results: Prov _____ City _____ Mun _____ Indigenous Group: (Please specify) Percent OPT Plus Coverage: 0-59 months old _________ 0-71 months old _________ Total No. with OPT Plus Results:
Percent OPT Plus Coverage: Prov _____ City _____ Mun _____ _______________________________________________ No. of Indigenous PS measured: 0-59 months old _________ 0-71 months old _________ Percent OPT Plus Coverage:
CY 20______ Prevalence Rate UW & SUW1/: ___________ _______________________________________________ Prevalence Rate of UW & SUW: 0-59 months old _________ 0-71 months old _________ CY 20______ Prevalence Rate UW & SU
Age Length/Height for Age Status Total, by age group Age
Group Normal (N) Stunted /Short (St) Severely Stunted (SSt) Tall (T) TOTAL Total N Total St Total SSt Total T Group
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (1)
0-5 . 0-5
months months
(R1) (R1)
6-11 6-11
months months
(R2) (R2)
12-23 12-23
months months
(R3) (R3)
24-35 24-35
months months
(R4) (R4)
36-47 36-47
months months
(R5) (R5)
48-59 48-59
months months
(R6) (R6)
60-71 60
months months
(R7) (R7)
Total (R8) Total (R8)
0-59 mos 0-59 mos
0-71 mos 0-71 mos
Prev (R9) Prev (R9)
0-59 mos 0-59 mos
0-71 mos 0-71 mos
Note: a) R1 means Row No. 1, R2 means Row 2, etc. b)Total (R8) - refers to the sum of preschoolers by nutritional status and by age group c) Prev (R9)- refers to the prevalence rate by sex, by nutritional status for age group 0- 59 months and 0- 71 months Note: a) R1 means Row No. 1, R2 means Ro
d) Prev (C22,24,26,28)- refers to the prevalence rate by total by age group 1/ Refers to previous year prevalence rate of the area 2/ 0-59 months = 13.5 x Total Population 3/ 0-71 months = 16.2 x Total Population d) Prev (C22,24,26,28)- refers to the p
Use WEIGHT-FOR-LENGTH for 0-2
Use WEIGHT-FOR-LENGTH or WE
Prepared by: ________________________________________ Validated by: ______________________________________________ Approved by: __________________________________ Prepared by: ______________________
Name and Signature of Nutrition Officer III Name and Signature of Nutrition Programme Coordinator Name and Signature of Director
Date: ___________________________ Date: ___________________________ Date: ___________________________ Date: ___________________________
OPT Plus Form 4A. Regional Summary Report on Operation Timbang Plus
Region _______________________ Year/Period of Measurement _________________________ Estimated No. of PS: 0-59 months old2/_________ 0-71 months old3/_________
Total No. of Prov ____ City ____ Mun ____ Total Population of Region/Source ____________________ Actual No of PS measured: 0-59 months old _________ 0-71 months old _________
Total No. with OPT Plus Results: Prov ____ City ____ Mun ____ Indigenous Group: (Please specify) Percent OPT Plus Coverage: 0-59 months old _________ 0-71 months old _________
Percent OPT Plus Coverage: Prov ____ City ____ Mun ____ _______________________________________________ No. of Indigenous PS measured: 0-59 months old _________ 0-71 months old _________
CY 20______ Prevalence Rate UW & SUW1/: ___________ _______________________________________________ Prevalence Rate of UW & SUW: 0-59 months old _________ 0-71 months old _________
Weight for Length/Height Status Total, by age group
Normal (N) Wasted (W) Severely Wasted (SW) Overweight (OW) Obese (Ob) TOTAL Total N Total SW Total SW Total OW Total Ob
(2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)
Prepared by: ________________________________________ Validated by: ______________________________________________ Approved by: __________________________________

Name and Signature of Nutrition Officer III Name and Signature of Nutrition Programme Co Name and Signature of Director
Date: ___________________________ Date: ___________________________ Date: ___________________________

OPT Forms Series NG Divine

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OPT Forms Series NG Divine

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Republic of the Philippines

Prepared By: _____________________________________________ Checked: __________________________________________________________

Prepared by: __________________________________________ Checked: ___________________________________________ Approved: ____________________________________

Prepared by: __________________________________________ Checked: ___________________________________________ Approved: ____________________________________

Prepared by: ________________________________________ Checked: ___________________________________________ Approved: ____________________________________

Barangay: ___________________________________ Province: ________________________________

Prepared by: ______________________________ Checked: ___________________________________________ Approved: _________________________________

City/Municipality ________________ Total No. of Barangays _________________________ Year/Period of Measurement _____________

Prepared by ___________________________________________ Approved ___________________________________________ Noted: _____________________________________

Date __________________________________ Date __________________________________ Date __________________________________

City/Municipality ________________ Total No. of Barangays _________________________ Year/Period of Measurement _____________

Prepared by ___________________________________________ Approved ___________________________________________ Noted: _____________________________________

Date __________________________________ Date __________________________________ Date __________________________________

City/Municipality ________________ Total No. of Barangays ___________________ Year/Period of Measurement _____________

Prepared by ___________________________________________ Approved ___________________________________________ Noted: _____________________________________

Date __________________________________ Date __________________________________ Date __________________________________

City/Municipality ________________ Total No. of Barangays _________________________ Year/Period of Measurement _____________

Date __________________________________ Date __________________________________ Date __________________________________

ation 3/ 0-71 months = 16.2 x Total Population

Prepared by: __________________________________________________ Checked: ___________________________________________ Approved: ____________________________________

Province ____________________ Total No. of Municipalities _________________________ Year/Period of Measurement _____________

Prepared by ___________________________________________ Approved ___________________________________________ Noted: _____________________________________

Prepared by ___________________________________________ Approved ___________________________________________ Noted: _____________________________________ Prepared by _______

________________________________________ Approved ___________________________________________ Noted: _____________________________________ Prepared by ________________________

nce ____________________ Total No. of Municipalities _________________________ Year/Period of Measurement _____________

Use WEIGHT-FOR-LENGTH for 0-23 months old preschool children

d by ___________________________________________ Approved ___________________________________________ Noted: _____________________________________

____________________________________ Date _____________________________________ Date _____________________________________

Region: _____________________ Total Population of Province/Source: ______________________________

Prepared by: ___________________________________________ Checked: ___________________________________________ Approved: __________________________________

Region: _____________________ Total Population of Province/Source: ______________________________ Region: ______________

Region: _____________________ Total Population of Province/Source: ______________________________

Prepared by: ___________________________________________ Checked: ___________________________________________ Approved: __________________________________

Prepared by ____________________________________ Approved _________________________________________________ Noted: _____________________________________

Prepared by ____________________________________ Approved _________________________________________________ Noted: _____________________________________

Prepared by ____________________________________ Approved _________________________________________________ Noted: _____________________________________

Prepared by ____________________________________ Approved _________________________________________________ Noted: _____________________________________

Prepared by: _____________________________________ Validated by: __________________________________________ Date __________________________

Prepared by: ________________________________________ Validated by: ______________________________________________ Approved by: __________________________________

Prepared by: ________________________________________ Validated by: ______________________________________________ Approved by: __________________________________

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Prepared By: _ Checked: ______________

Prepared by: ____________________ Checked: _ Approved: ________________

Prepared by: ____________________ Checked: _ Approved: ________________

Prepared by: __________________ Checked: _ Approved: ________________

Barangay: ___ Province:

Prepared by: ________ Checked: _ Approved: _____________

City/Municipality ____ Total No. of Barangays _ Year/Period of Measurement _

Prepared by _____________________ Approved _ Noted: _________________

Date Date Date __

City/Municipality ____ Total No. of Barangays _ Year/Period of Measurement _

Prepared by _____________________ Approved _ Noted: _________________

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City/Municipality ______ Total No. of Barangays _ Year/Period of Measurement _____

Prepared by _____________________ Approved _ Noted: _________________

Date Date Date __

City/Municipality ____ Total No. of Barangays _ Year/Period of Measurement _

Date Date Date __

Prepared by: ____________________________ Checked: _ Approved: ________________

Province ________ Total No. of Municipalities _ Year/Period of Measurement _

Prepared by _____________________ Approved _ Noted: _________________

Prepared by _____________________ Approved _ Noted: ___________ Prepared by _

________________ Approved _ Noted: _ Prepared by ______

nce ________ Total No. of Municipalities _ Year/Period of Measurement _

d by _____________________ Approved _ Noted: _________________

__________________ Date _ Date ___________________

Region: _ Total Population of Province/Source: __________

Prepared by: _____________________ Checked: _ Approved: ______________

Region: _____ Total Population of Province/Source: Region:

Region: _ Total Population of Province/Source: __________

Prepared by: _____________________ Checked: _ Approved: ______________

Prepared by ____________ Approved _ Noted: _____________

Prepared by ____________ Approved _ Noted: _____________

Prepared by ____________ Approved _ Noted: _____________

Prepared by ____________ Approved _ Noted: _____________

Prepared by: _________ Validated by: Date

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