You are on page 1of 1

MEF REQUISITION TOOL.

REGION: KAMPALA
CENTER NAME: VICTORY

CLIENTS AGE DIAGNOSIS REGIMEN VIRAL MEF BEING AMOUNT CLIENTS


NAME LOAD REQUESTED CONTACTS.
i.e. Labs,
Xray, Meds
Byamukama 42 Malaria TLD Det Meds 60,000 0751650120
Rogers
Lwanga Juma 17 Skin Rash TLD Det Meds 210,000 0709170364
Nakazibwe 37 Malaria/Fever TLD Undet Meds, Labs 100,000 0774343271
Rosemary
Nakachwa 40 Candidiasis, TLD Undet Meds, Food 75,000 + 0704938582
Ruth Immune Supplements 54,000 =
Suppressed, 129,000
joint pains,
body
weakness
Nabasiige 28 Mental Health TLD Det Meds 28,000 0704350893
Joan illness
Nakandi 28 UTI TLD Det Meds 115,000 0758790850
Sharifah
Nakato 32 Candidiasis TLD Det Food 54,000 0706537655
Deborah Supplements
Transport 30,000
TOTAL 726,000
Nakachwa 40 Malaria, TLD Det Labs, Meds 88,500 0704938582
Ruth Typhoid

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.

You might also like