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MEF REQUISITION TOOL.

REGION: KAMPALA
CENTER NAME: VICTORY

CLIENTS NAME AGE DIAGNOSIS REGIMEN VIRAL MEF BEING AMOUNT CLIENTS
LOAD REQUESTED CONTACTS.
i.e. Labs,
Xray, Meds
Kyomugisha 47 Respiratory LTD UnDet Meds 20,000 0706543567
Ramula Infections
Tumulanze 35 UTI, Cystitis TLD UnDet Labs, scan, 218,000 0700650120
Florida meds
Pauline 43 UTI, Fever, TLD UnDet Labs, Meds 100,600 0754151001
Nabulya Headache
Newombe 33 Syphillis - TLD 1432 Labs, Meds 169,000 0708951420
Irene acquired
Edmond 47 UTI TLD UnDet Labs, Meds 160,000 C/o
Amanya 0752788629
Nakamatte 23 New TLD Det Nutritional 54,000 C/o
Gloria Mother Supplements 0773249251
Wanyana 47 High TLD UnDEt Meds 48,000 0702402559
Rebecca Cholestral
Transport 30,000

N/B

- Requests should be sent in immediately they are received. Clients should bring in their
requests as soon as received within 2 days. Encourage them to do so.
- All liquidations should be sent in by Friday
- All liquidations should include the prescription and the receipts and attach the liquidation
forms and receipts together.

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