BNS Form No.

1A
Philippine Plan of Action for Nutrition
FAMILY PROFILE

Purok/Sitio:____________________ Municipality: ALFONSO LISTA

Barangay: CALUPAAN Province: IFUGAO
No. of Children Name of Household Head/Spouse Occupation Educatio Check if: Check if: Fill in: Check if:
No. of nal Couple Nursing < 6 mos. Old Toilet on
HH HH <6 6-23 24-59 >60 Attainme Mother practicing type Water Activity HH using HH
No. Membe mos. mos. mos. mos. nt Pregnan Mixed Iodized using
rs Old Old Old Old t family EBF Others (WS,OP, Source (VG,P/L, salt
planning Feeding O,N) (P,S,W) FP) IFR
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
(F)
(M)
Abbreviations
CF-Complementary Feeding (F)- Father Educational Attainment Water Source Food Production
EBF- Exclusive Breastfeeding (M)- Mother EU-Elem. Undergraduate CU- College Undergraduate P- Pipe VG- Vegetable Garden
HH-Household EG-Elem. Graduate CG- College Graduate W- Well P/L- Poultry/Livestock
IFR-Iron Fortified Rice HU- HS Undergraduate V- Vocational S- Spring FP-Fishpond
HG- Graduate O- Others