Internal facility Report and Resupply form(IFRR) for all DU

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

Reporting period: from to E.C

COMPLETED BY UNIT COMPLETED BY STORE

PRODUCT DESCRIPTION
Calculated Maximum Quantity
Beginning Quantity Ending Quantity to be
S.NO Unit of issue Loss/adj needed to reach
balance received balance supplied
consumption quantity max

A B C D E=A+B+/-C-D F=EX2 G=F-D H

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Completed by (Name,date and signature): Completed by

(Name,date
and signature):

Approved by (Name,date and signature)

Distribution: 1st copy to pharmacy store & 2nd copy to remain with the pad