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

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

Reporting Period: From: 16/042011 To:02/05/2011

Completed by Dispensing Unit (DU) Completed by Store

Maximum
Beginnin Quantity Loss/ Ending Calculated Stock Quantity Quantity
g Balance Received Adjustment Balance Consumption Quantity to Order Supplied

Ser. Unit of E= A+B +C -

No. Product Description Issue A B C D D F=E*2 G = F-D H
Examination glove 100
1 small size 0 5 0
Portable oxygen each
cylinder with gas
2 0 2 0
3 glucometer each 0 1 0

4 oxygen gas each 0 8 0

Valve replacement each

5 with test 0 2&1 0
6 alcohol 70% litter 1 0 0

7 adhesive plaster 1*4 0 5 0

8 Cotton roll 10 0 0

9 disposable syringe 3cc 100 4 0 0

10 Thermometer each 0 2 0
11 surgical gouze each 0 5 0

12 surgical blead 100 0 4 0

13 Resomal sachet  0 30 0

14 plumpy nut ctn 0 2 0

15 F-100 Tin 0 11 0
Tin 0
16 F-75 0 11