internal Facility Report and Resupply Form (IFRR) Page 1/4

Name of Dispensing Unit: laboratory Maximum Stock Level (ML) = 1month

Reporting Period: From: 21/04/2011 To: 07/05/2011
Completed by Dispensing Unit (DU) Completed by Store
Quantity Calculated Maximum
Ser Beginning Loss/ Ending Quantity Quantity
Unit of Receive Consumptio Stock
. Product Description Balance Adjustment Balance to Order Supplied
Issue d n Quantity
No.
E= A+B +C
A B C D F=E*2 G = F-D H
-D
I. Drugs                
1.LABORATORY SUPPLIES                  

1 cover slide 10*100

2 pregnant test strips box

3 capillary tube pkt

4 H-Pylori test surum box

stool spacimen cup

5 pcs
examination glove medium 100
6 size
gouze surgical Roll
7

8 EDTA coated test tube 50

9 Blood lancet of 500 pkt

10 Glucometer each
non-frosted microscop slide
11 50
 surgical blead
12 pkt

frosted slide
13 50
disposable syringe 3cc
14 100

disposable syringe 5cc

15 100
disposable syrige 10cc 100
16
surgical glove 7.5 pair 50
17

absorbent cotton
18 100g
applicator stick with cotton 100
19 tip
applicator stick with out 1000
cotton tip
20
HCV test cassette –serum
21 box

HBV AG test card

22 box
urine analysis multi deep
23 stick 150
filter papper
24 100
Primo star microscope Each
25
 Hematocrite micro each
26 centrifuge
blood group anti A.B.D
27 antibody 3*10ml
Alcohol
28 litter
Heamatocrit sealant
29 each
30 oil emerssion 100ml
31 ethanol 500ml
32 Methanol 1litter
33 Glycerol 1litter
34  RPR test strip  50            
35  Lence paper  100            
36  Safty box  each            
37 Pasthur pipat  pcs            

38 Micro pipat tip(200-1000) Pcs

Completed by (Name, Date, and Signature) : bereket maru Completed by (Name, Date, and Signature) :

Approved by (Name, Date, and Signature): abera taemu Tadesse ewunetu

Distribution: First Copy to Pharmacy Store and Second copy to remain with the pad