Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU

Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D
1 ASA 100mg of 10 tablet 10x10
2 ASA 300mg of 10 tablet 100x10
3 Acyclovir 200mg of 10 tablet 10x10
4 Acyclovir 3% eye ointment tube
5 Acyclovir 5% skin cream tube
6 Adrenaline 0.1% in 1ml injection 100
7 Albendazole 100mg/5ml suspention bottle
8 Albendazole 400mg of 2 tabs 10x10
9 Antacid 200ml suspention bottle
10 Antacid 370mg cpd of 10 tabs 100x10
11 Aminophylline 250mg/10ml injection 50
12 Amitriptyline 25mg of 10 tabs 10x10
13 Amoxicillin 250mg of 10 caps 50x10
14 Amoxicillin 500mg of 10 caps 50x10
15 Amoxicillin 250mg/5ml, 100ml suspention bottle
16 Amoxicillin 125mg/5ml, 100ml suspention bottle
17 Allopurinol 100mg of 10 tabs 10x10
18 Augmentin 125mg+ 31.25mg/5ml,100ml susp bottle
19 Augmentin 250mg+ 62.5mg/5ml,100ml susp bottle
20 Augmentin 625mg of 7 tablet 5x3

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------
 Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU
Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D
21 Augmentin 375mg of 10 tablet 5x4
22 Ampicillin 250mgn of 10 capsule 50x10
23 Ampicillin 500mgn of 10 capsule 50x10
24 Ampicillin 250mg/5ml suspention bottle
25 Ampicillin 125mg/5ml suspention bottle
26 Ampicillin sodium 500mg injection 50
27 Anti-hamorrhoidal oint 15 gm tube
28 Anti-hamorrhoidal 30mg of 10 suppository 5x2
29 Almetamin 2.25mg of 10 tabs 10x10
30 Ascorbic acid(vit C) 50mg of 10 tabs 10x10
31 White field’s 6% +3% ointment, 20gm tube
32 Bisacodyl 100mg of 10 suppository 5x2
33 Carbamazepine 200mg of 10 tabs 10x10
34 Ceftriaxone 1gm injection vial
35 Ceftriaxone 500mg injection vial
36 Chloramphenicol 0.5%, 10ml eye/ear drop tube
37 Chloramphenicol 1%, 5gm eye ointment tube
38 Chloramphenicol 250mg of 10 capsule 50x10
39 Chloramphenicol sodium injection 1gm 50

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------
 Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU
Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D
40 Chlorpromazine 25mg of 10 tabs 1000
41 Chlorpromazine 25mg /ml in 2ml 50
42 Chlorpromazine 100mg of 10 tabs 1000
43 Chloroquine PO4 250mg of 10 tablet
44 Chloroquine PO4 50mg base/5ml syrup,60ml bottle
45 Chlorpheniramine maleate 4mg of 20 tabs 10x10
46 Chlorpheniramine maleate 2mg/5ml syrup,100ml bottle
47 Cimetidine 200mg/ml, 2ml injection 100
48 Cimetidine 400mg of 10 tabs 10x10
49 Ciprofloxacin 500mg of 10 tabs 10x10
50 Clotrimazole 1% cream, 20gm tube
51 Clotrimazole 100mg vaginal tabs of 6 pk
52 Cloxacillin 250mgof 10 caps 50x10
53 Cloxacillin 500mgof 10 caps 50x10
54 Cloxacillin 125mg/5ml suspention, 100ml bottle
55 Codeine po4 10mg/5ml linctus bottle
56 Dextromethorphan Hbr 15mg/5ml, 125ml syrup bottle
57 Dextrose 40% in 20ml injection 20
58 DNS 1000ml iv nfusion bag

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------
 Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU
Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D
59 Dw 1000ml iv nfusion bag
60 Diazepam 5mg of 10 tabs 10x10
61 Diazepam 5mg/2ml ,in 2ml inj 50
62 Diclofenac 50mg of 10 tabs 10x10
63 Dexamethasone eye drop 0.1%, 10ml tube
64 Diclofenac 75mg/3ml injection 100
65 Diphenhydramine Hcl 12.5mg/5ml elixir bottle
66 Doxycycline 100mg of 10 caps 20x10
67 Enalapril 10mg of 10 tabs 10x10
68 Erythromycin 200mg/5ml suspention bottle
69 Erythromycin 250mg of 10 tabs 50x10
70 Erythromycin 500mg of 10 tabs 50x10
71 Ferrous gluconate 300mg of 10 tabs 1000
72 Fso4 +folic acid 150mg+0.4mg of 10 tabs 1000
73 Ferrous sulphate drops 75mg/0.6ml,30ml bottle
74 Frusemide 40mg tablet 10x10
75 Fluocinolone 0.025%, 10gm cream tube
76 Gentamycin 0.3% eye/ear drop, 10ml tube
77 Gentamycin 80mg/2ml, 2ml injection 100

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------
 Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU
Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D
78 Glibenclamide 5mg of 10 tabs 10x10
79 Griseofulvin 125mg of 10 tabs 10x10
80 Hydralazine 20mg/ml, 1ml injection 5
81 Hydrochlorothizide 25mg of 10 tablet 10x10
82 Hydrocortisone acetate 1% ointment tube
83 Hydrocortisone 100mg injection vial
84 Hyoscine 20mg/ml injection 100
85 Hyoscine 10mg of 10 tablet 10x10
86 Ibuprofen 400mg of 10 tablet 10x10
87 Ichthamol 10%, 20gm ointment tube
88 Indomethacin 100mg of 10 suppository 5x2
89 Indomethacin 25mg of 10 caps 10x10
90 Ketoconazole 2%, 20gm skin cream tube
91 Ketoconazole 200mg of 10 tabs 10x10
92 Ky jelly 82gm tube
93 Levamisole 40mg of 4 tabs strip
94 Loratadine 10mg of 10 tabs blister
95 Mebendazole 100mg of 6 tabs 40x6
96 Mebendazole 100mg/5ml, 30ml suspention bottle

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------
 Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU
Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D
97 Metformine 500mg of 10 tabs 10x10
98 Methyldopa 250mg of 10 tablet 10x10
99 Methylsalicylate 25%,20gm oint tube
100 Metoclopramide Hcl 10mg of 10 tabs 10x10
101 Metoclopramide 0.2mg/drop, 100ml bottle 0
102 Metoclopramide 5mg /5ml, 2ml injection amps
103 Metronidazole 125mg/5ml, 100ml suspention bottle
104 Metronidazole 250mg of 10 caps 10x10
105 Miconazole nitrate 2%,30gm cream tube
106 Miconazole nitrate 40gm oral jel tube
107 Multivitamin 120ml syrup bottle
108 Multivitamin cpd tablet 10x10
109 Niclosamide 500mg of 10 tabs 10x10
110 Nifedipine 20mg of 10 tabs 10x10
111 Norfloxacin 400mg of 10 tabs 10x10
112 Normal saline 1000ml iv infustion bag
113 Nystatin 500,000 iu of 10 tabs 10x10
114 ORS 27.9gm sachet
115 Omeprazole 20mg of 10 tabs 10x10

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------
 Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU
Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D
116 Paracetamol 120mg/5ml,60ml syrup bottle
117 Paracetamol 125mg of 5 suppository 20x5
118 Paracetamol 500mg of 10 tabs 10x100
119 Paracetamol 100mg of 10 tabs 10x10
120 Penicillin G benzathine 4miu injection 50
121 Penicillin G sodium crystalline 1miu injection 50
122 Phenobarbitone 100mg tabs 1000
123 Phenobarbitone 30mg tabs 1000
124 Potassium chloride 600mg tabs 500
125 Phenytoin sodium 50mg tabs 20x10
126 Piprazine citrate 500mg/5ml elixir,30ml bottle
127 Praziquantel 600mg of 10 tabs 10x10
128 Prednisolone 5mg tabs 1000
129 PPF 4miu injection,10ml 50
130 Promethazine 25mg tabs 1000
131 Promethazine 5mg/5ml elixir,100ml bottle
132 Pyridoxine(vit B6) 100mg 10x10
133 Quinine 300mg of 10 tabs 500
134 Quartem of 24 tablt strip

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------
 Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU
Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D
135 Ringer lactate 1000ml iv infusion bag
136 Salbutamol 2mg of 10 tabs 10x10
137 Salbutamol 2mg/5ml, 100ml syrup bottle
138 Salbutamol oral inhalation 0.1mg/dose vial
139 Salbutamol 4mg of 10 tabs 10x10
140 Snake venom antiserum(antirabies) 100ml vial
141 Spectinomycin 2gm injection vial
142 Spironolactone 2mg of 10 tabs 10x10
143 Sulphamethoxazole+trimethoprim 480mgx10 10x100
144 Sulphamethoxazole+trimethoprim 960mgx10 10x100
145 Sulphamethoxazole+trimethoprim 240mg/5ml susp bottle
146 Sulphur 10% ointment, 50gm tube
147 Terracotril 4ml eye/ear suspention tube
148 TAT 1500iu injection amps
149 Tetracycline 1%,4gm eye ointment tube
150 Tetracycline 250gm of 10 capsule blister
151 Tetracycline 3% skin ointment, 15gm tube
152 Thiabendazole 100mg/5ml suspention bottle
153 Thiabendazole 500mg of 6 tablet blister

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------
 Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU
Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D
154 Tinidazole 500mg of 4 tablet 60x4
155 Theoephidrine 131mg 10x100
156 Tramadole 50mg of 10 tablet 10x10
157 Vitamin B complex cpd 10x10
158 Vitamin B complex 2ml injection 100
159 Vit B1+ B6+ B12 cpd injection amps
160 Vit B1+ B6+ B12 cpd of 10 tablet 10x10
161 Vitamin k 10mg/ml, 1ml injection 6
162 Water for injection 5ml amps
163 Water for injection 10ml 50
164 White petrolatum 50gm ointment tube
165 Xylometazoline nasal drop 10ml tube
166 Zinc oxide 15% ointment ,20gm tube
Medical supplies
167 Elastic bandage 8cmx5m dozen
168 Catgut chromic 2/0,75cm dozen
169 Syringe with needle 2ml pcs
170 Syringe with needle 3ml 100
171 Syringe with needle 5ml 100
172 Syringe with needle 10ml 100
173 Syringe with needle 20ml 50

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------
 Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU
Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D
174 Foly catheter adult size each
175 Foly catheter pediatric size each
176 Iv cannula pedietric 24g 100
177 Iv cannula adult 16g 100
178 Adult NG tube pcs
179 Pediatric NG tube pcs
180 Silik 2/0, 75cm dozen
181 Scalp vein(buter fly needle) pcs
182 Surgical glove size 7.5 50pairs
183 Surgical blade 100
184 zink acetate 10 mg 10x10
185 plumpy nut 150
186 plumpy sup 150
187 silik 3/0, 75cm dozen
188 insulin syring 1cc 100

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------
 Internal facility Report and Resupply form(IFRR) OPD PHARMACY DU
Name of dispensing unit opd pharmacy maximum stock Level(ML) -------------------

Reporting period: from --/--/2011 to 30/--/2011 E.C

COMPLETED BY UNIT COMPLETED BY STORE
Calculated Maximum Quantity
Unit of Beginning Quantity Ending Quantity to
Loss/adju consumptio needed to
S.NO PRODUCT DESCRIPTION balance received balance quantity be supplied
issue n reach max
E=A+B+/-
A B C D F=EX2 G=F-D H
C-D

Completed By------------------- Approved By ------------- Completed and Issued By ----------------

Signature----------- Signature --------- Signature ------------------
Date -------------- Date --------- Date ----------