MM-001-1

Republic of the Philippines

Department of Health
CAGAYAN VALLEY MEDICAL CENTER
Dalan Na Pagayaya, Regional Government Center
Carig Sur, Tuguegarao City, Cagayan

REQUISITION AND ISSUE SLIP

Division: NURSING Responsibility Center Code

Office: OB-GYNE WARD RIS No.: Date:

Requisition Stock Issue

Available?
Stock No. Unit Description Quantity Yes No Quantity Remarks Fund luster

BOX FACE MASK 150

PCS KN95 100
PCS FACE SHIELD 100
PCS BOUFANT 100
PCS TYPE B PPE 100
PCS TYPE A PPE 100

PURPOSE: FOR OB-GYNE USE.

Requested by: Approved by: Issued by: Received by:

Signature
Printed Name
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