FP Commodity Inventory and Consumption Report Form

Name of RHU/CHO: ___________________

Province: ____________________________
Region: _____________________________
Dates Covered: ____________________________
Date Accomplished: _________________________ C

Transfers
Total Available Total
Quantity (issued to
Stock Adjustments (B+C+D+E) -/+ quantity Losses
received other
available/ Quantity (F) issued
C/MHO)
Commodity Beginning procured
Balance (C/MHO/RHU)
DOH
(C/MHO/RHU)
Central Others Month 1 Month 2 Month 3 TOTAL
Office
Pills (COC)
0
cycle
Pills (POP)
0
cycle
DMPA
0
(vial)
IUD
0
(pc)
Implant
0
(pc)
Male condom
0
(pc)

PREPARED BY: DESIGNATION:

CONTACT NUMBER E-MAIL:
FAMILY PLANNING INVENTORY AND ORDER FORM

NAME OF FACILITY: BHS _________________ NAME OF PROVINCE: Samar

DATES COVERED: March 2018 REGION: VIII
DATE ACCOMPLISHED: ________________

A B C D E F G H I J K L M N O P Q
Quantity received Adjustments Total Quantity issued Requirements
Stocks on Average
Total Available
Stock Available/ Hand/ Monthly
Available TOTAL Months of Authorized
Commodity Beginning Ending Usage/ REMARKS

Month 1

Month 2

Month 3
DOH Quantity
Balance Addition Subtraction (B+C+D+E)- ISSUANCE
Balance Issuance
Supply Stock Level
Central Others F (L ÷ M) required
(+) (-) (G-K) K÷3 (6-N)
Office (O x M)
(in months)

Pills (COC)
(cycle)

Pills (POP)
(cycle)

DMPA
(vial)

IUD
(pc)

Implant
(pc)

Male condoms
(pc)

PREPARED BY: NOTED BY:

Designation : _____________________ Designation: _______________________

CONTACT NUMBER: _______________ CONTACT NUMBER: ________________
EMAIL ADDRESS: _________________ EMAIL ADDRESS: ___________________
FAMILY PLANNING INVENTORY AND ORDER FORM

NAME OF BHS: NAME OF PROVINCE: Samar

DATES COVERED: April 2018 REGION: VIII
DATE ACCOMPLISHED:

A B C D E F G H I J K L M N O P Q
Quantity received Adjustments Total Quantity issued Requirements
Stocks on Average
Total Available
Stock Available/ Hand/ Monthly
Available TOTAL Months of Authorized
Commodity Beginning Ending Usage/ REMARKS

Month 1

Month 2

Month 3
DOH Quantity
Balance Addition Subtraction (B+C+D+E)- ISSUANCE
Balance Issuance
Supply Stock Level
Central Others F (L ÷ M) required
(+) (-) (G-K) K÷3 (6-N)
Office (O x M)
(in months)

Pills (COC)
- - - - #DIV/0! #DIV/0! #DIV/0!
(cycle)

Pills (POP)
- - - - #DIV/0! #DIV/0! #DIV/0!
(cycle)

DMPA
- - - - #DIV/0! #DIV/0! #DIV/0!
(vial)

IUD
- - - - - - - #DIV/0! #DIV/0! #DIV/0!
(pc)

Implant
- - - - #DIV/0! #DIV/0! #DIV/0!
(pc)

Male condoms
- - - - #DIV/0! #DIV/0! #DIV/0!
(pc)

- - - #DIV/0! #DIV/0! #DIV/0!

PREPARED BY: NOTED BY:

DESIGNATION: ___________________ DESIGNATION:_____________________

CONTACT NUMBER: _______________ CONTACT NUMBER: ________________
EMAIL-ADDRESS: _________________ EMAIL-ADDRESS: __________________