Republic of the PhilippinesSan Roque Central Elementary School

San Roque, Northern Samar-o0o-

NUTRITIONAL STATUSEnd line Data

Date of Weighing______________Name Birth

dateAge Weight Height Ht 2 BMI NS

Summary:Male Female

Overweight ______ _____Normal ______ _____Wasted ______ _____Severely Wasted ______ _____

Prepared by:

_________________________Adviser