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Region III

Division of Bulacan

NUTRITIONAL STATUS REPORT


School: Teacher:
Grade: Date:
Deped Memo No. 165, s 2010
Boys # Names Date Taken Birthday Age Weight(kg) Height(cm) BMI
1 Alcasid, Romeo 6/20/2018 2/24/2000 18 40 152 17.31
2 Arceo, Janelle Andrei B. 6/20/2018 9/20/2000 17 40 154 16.87
3 Bautista, Mikko Carlo B. 6/20/2018 3/12/1999 19 32 125 20.48
4 Bello, Mico S. 6/20/2018 4/15/2002 16 50.5 165 18.55
5 Borjal, Martin Dave D. 6/20/2018 5/8/2002 16 43.5 162 16.58
6 Bulawan, Rovic A. 6/20/2018 10/23/2002 15 56 158 22.43
7 Gamboa, Julius Redhanz C. 6/20/2018 7/10/1999 18 44 165 16.16
8 Matawaran, Louie C. 6/20/2018 10/3/2003 14 53.5 162 20.39
9 Metre, Jomar I. 6/20/2018 10/11/2002 15 42 125 26.88
10 Perdragosa, Moises B. 6/20/2018 8/13/2001 16 54 171 18.47
11 Rivera, Ron Russel F. 6/20/2018 8/10/2002 15 60.5 158 24.23
12 Sidiangco, Sher-Jhon N. 6/20/2018 12/13/1999 18 40.5 158 16.22
13 Ulanday, Christian M. 6/20/2018 12/23/2003 14 46 168 16.30
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Submitted by:

0
Adviser

Checked by:
Clinic Teacher

Noted:
Region III
vision of Bulacan

NAL STATUS REPORT

REMARKS
Normal
Normal
Normal
Normal
Normal
Normal
Wasted
Normal
Normal
Normal
Normal
Wasted
Normal
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Region III
Division of Bulacan

NUTRITIONAL STATUS REPORT


School: Teacher:
Grade: Date:
Deped Memo No. 165, s 2010
Girls # Names Date Taken Birthday Age Weight(kg) Height(cm) BMI
1 Apas, Antonete A. 6/20/2018 11/16/2001 16 44 154 18.55
2 Atanante, Anne Shellane T. 6/20/2018 8/5/2000 17 37 148 16.89
3 Constantino, Evelyn G. 6/20/2018 8/14/2001 16 44 156 18.08
4 Dela Passion, Rochelle 6/20/2018 6/5/2000 18 48 149 21.62
5 Doinog, Trixia Mae T. 6/20/2018 5/13/2001 17 50 157 20.28
6 Dolozo, Dorly P. 6/20/2018 12/13/2000 17 45 156 18.49
7 Esmundo, Ma. Cecilia L. 6/20/2018 2/5/2000 18 46 145 21.88
8 Evangelista, Melca T. 6/20/2018 12/8/2001 16 54 154 22.77
9 Guerrero, Pearly Joyce S. 6/20/2018 9/12/2000 17 52 156 21.37
10 Gumatay, Christine L. 6/20/2018 12/5/2002 15 51 157 20.69
11 Manalese, Maria Elmira D. 6/20/2018 6/28/2003 14 58 150 25.78
12 Mercano, Leonalyn Mary S. 6/20/2018 12/1/2002 15 41 151 17.98
13 Nemenio, Shekena P. 6/20/2018 7/15/2001 16 45 154 18.97
14 Paller, Nicole Grace C. 6/20/2018 9/23/2003 14 42 148 19.17
15 Reolope, Olivia May F. 6/20/2018 6/3/2003 15 40.8 150 18.13
16 Tuquero, Erica S. 6/20/2018 2/20/2003 15 45 153 19.22
17 Ulpindo, Shina Rose E. 6/20/2018 6/22/2003 15 48 158 19.23
18 Valencia, Jen-Ann M. 6/20/2018 9/22/2001 16 44 150 19.56
19 Velasco, Ericka Mae V. 6/20/2018 8/8/2001 16 45 151 19.74
20 ###
21 0 ###
22 0 ###
23 0 ###
24 0 ###
25 0 ###
26 0 ###
27 0 ###
28 ###
29 0 ###
30 ###

Submitted by:

0
Adviser

Checked by:

Clinic Teacher
Noted:
Region III
vision of Bulacan

ONAL STATUS REPORT

REMARKS
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
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#DIV/0!
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
City Schools Division of Dasmariñas

NUTRITIONAL STATUS SUMMARY REPORT

School:
Teacher:
Grade:
Date:
Table A. Tabulated Data Presentation

Boys Girls Total


Nutrition Result Total Percent Total Percent Total Percent
Severely Wasted: 0 0.00 0 0.00 0 0.00
Wasted: 2 15.38 0 0.00 2 6.25
Normal: 11 84.62 19 100.00 30 93.75
Overweight: 0 0.00 0 0.00 0 0.00
Obese: 0 0.00 0 0.00 0 0.00
Grand Total 13 100.00 19 100.00 32 100.00

Table B. Graphical Data Presentation

Nutrition Status Percentage


Severely Wasted: 0.00
Wasted: 6.25
Normal: 93.75
Overweight: 0.00
Obese: 0.00
CREATED BY: DOMINICK L. DERILO

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