3.4 Penilaian Status Gizi Balita.doc

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PENILAIAN STATUS GIZI BALITA Namabalita Namaibu Jeniskelamin Tempat/tanggallahir Usia(bln)

: : : : :

FormulirPenilain Status GiziBalita Tanggal : _________________ 1. Antropometri TB/PB : Cm BB Aktual: Kg 2. Data Biokimia (Hasil Lab.)

3. Fisikdanklinis

4. Konsumsi

5. Data Personal

Assessment Z-SCORE BB/U : TB/U atau PB/U : BB/TB :

KATEGORI STATUS GIZI _____________________ _____________________

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