Internal Facility Report and Resupply Form (IFRR) Page 4/4

Name of Dispensing Unit: adult OPD Maximum Stock Level (ML) = 1MONTH
Reporting Period: From: 15/04/2011 To:30/04/2011
Completed by Dispensing Unit (DU) Completed by Store
Quantity Calculated Maximu
Beginning Receive Loss/ Consumptio m Stock Quantity
Balance d Adjustment Ending Balance n Quantity to Order Quantity Supplied
Product Unit of E= A+B +C
Ser. No. Description Issue A B C D -D F=E*2 G = F-D H
Examination glove 100
small size
1 0 0 0 0 0 0 0   3
stat pack hiv test pkt
kit

2 0 0 0 0 0 0 0 5
3 absorbable cotton 100g 0 0 0 0 0 0 0 5

4 tounge deppresor 100 0 0 0 0 0 0 0 3

wooden

termometer each

5 0 0 0 0 0 0 0 4