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COMBINED REPORT, REQUISITION, ISSUE AND RECEIPT FORM (CRRIRF) - Antiretroviral and Cotrimoxazole

SiteName	SiteName			Data Consultant Name ValidateEntry
Facility Code	formid	Funding Source	Funding_Source
State	State	Service Type	Service_Type
Phase	Phase	IPName	IPName

S/No	Drugs	Basic Unit	Beginning Balance for Reporting Period	Quantity Received during Reporting Period	Quantity Dispensed During Reporting Period	Positive Adjust.	Negative Adjust.	Ending Balance (Physical Count)	Remarks
FIXED DOSE COMBINATION ADULT FIRST LINE
1	Drug_1	60 tabs	BeginningBal_1	QtyReceived_1	Qty_Dispensed_1	Positive_Adjst_1	Negative_Adjst_1	QtySOH_1	Remark_1
2	Drug_2	30 tabs	BeginningBal_2	QtyReceived_2	Qty_Dispensed_2	Positive_Adjst_2	Negative_Adjst_2	QtySOH_2	Remark_2
3	Drug_3	60 tabs	BeginningBal_3	QtyReceived_3	Qty_Dispensed_	Positive_Adjst_3	Negative_Adjst_3	QtySOH_3	Remark_3
4	Drug_4	30 tabs	BeginningBal_4	QtyReceived_4	Qty_Dispensed_4	Positive_Adjst_4	Negative_Adjst_4	QtySOH_4	Remark_4
5	Drug_5	30 tabs	BeginningBal_5	QtyReceived_5	Qty_Dispensed_5	Positive_Adjst_5	Negative_Adjst_5	QtySOH_5	Remark_5
SINGLE DOSE ADULT FIRST LINE
6	Drug_6	30 tabs	BeginningBal_6	QtyReceived_6	Qty_Dispensed_6	Positive_Adjst_6	Negative_Adjst_6	QtySOH_6	Remark_6
7	Drug_7	60 tabs	BeginningBal_7	QtyReceived_7	Qty_Dispensed_7	Positive_Adjst_7	Negative_Adjst_7	QtySOH_7	Remark_7
8	Drug_8	60 tabs	BeginningBal_8	QtyReceived_8	Qty_Dispensed_8	Positive_Adjst_8	Negative_Adjst_8	QtySOH_8	Remark_8
ADULT SECOND LINE DRUGS
9	Drug_9	120 tabs	BeginningBal_9	QtyReceived_9	Qty_Dispensed_9	Positive_Adjst_9	Negative_Adjst_9	QtySOH_9	Remark_9
10	Drug_10	30 tabs	BeginningBal_10	QtyReceived_10	Qty_Dispensed_10	Positive_Adjst_10	Negative_Adjst_10	QtySOH_10	Remark_10
PEDIATRIC FIXED DOSE COMBINATION
11	Drug_11	60 tabs	BeginningBal_11	QtyReceived_11	Qty_Dispensed_11	Positive_Adjst_11	Negative_Adjst_11	QtySOH_11	Remark_11
12	Drug_12	60 tabs	BeginningBal_12	QtyReceived_12	Qty_Dispensed_12	Positive_Adjst_12	Negative_Adjst_12	QtySOH_12	Remark_12
13	Drug_13	60 tabs	BeginningBal_13	QtyReceived_13	Qty_Dispensed_13	Positive_Adjst_13	Negative_Adjst_13	QtySOH_13	Remark_13
14	Drug_14	6o tabs	BeginningBal_14	QtyReceived_14	Qty_Dispensed_14	Positive_Adjst_14	Negative_Adjst_14	QtySOH_14	Remark_14
PEDIATRIC SINGLE DOSE
15	Drug_15	60 tabs	BeginningBal_15	QtyReceived_15	Qty_Dispensed_15	Positive_Adjst_15	Negative_Adjst_15	QtySOH_15	Remark_15
16	Drug_16	90 scr tabs	BeginningBal_16	QtyReceived_16	Qty_Dispensed_16	Positive_Adjst_16	Negative_Adjst_16	QtySOH_16	Remark_16
17	Drug_17	30 tabs	BeginningBal_17	QtyReceived_17	Qty_Dispensed_17	Positive_Adjst_17	Negative_Adjst_17	QtySOH_17	Remark_17
18	Drug_18	25ml	BeginningBal_18	QtyReceived_18	Qty_Dispensed_18	Positive_Adjst_18	Negative_Adjst_18	QtySOH_18	Remark_18
19	Drug_19	100ml	BeginningBal_19	QtyReceived_19	Qty_Dispensed_19	Positive_Adjst_19	Negative_Adjst_19	QtySOH_19	Remark_19
PEDIATRIC SECOND LINE DRUGS
20	Drug_20	60 tabs	BeginningBal_20	QtyReceived_20	Qty_Dispensed_20	Positive_Adjst_20	Negative_Adjst_20	QtySOH_20	Remark_20
21	Drug_21	300ml	BeginningBal_21	QtyReceived_21	Qty_Dispensed_21	Positive_Adjst_21	Negative_Adjst_21	QtySOH_21	Remark_21
OPPORTUNISTICS INFECTIOUS DRUGS
22	Drug_22	tabs	BeginningBal_22	QtyReceived_22	Qty_Dispensed_22	Positive_Adjst_22	Negative_Adjst_22	QtySOH_22	Remark_22
23	Drug_23	tabs	BeginningBal_23	QtyReceived_23	Qty_Dispensed_23	Positive_Adjst_23	Negative_Adjst_23	QtySOH_23	Remark_23
24	Drug_24	tabs	BeginningBal_24	QtyReceived_24	Qty_Dispensed_24	Positive_Adjst_24	Negative_Adjst_24	QtySOH_24	Remark_24
25	Drug_25	tabs	BeginningBal_25	QtyReceived_25	Qty_Dispensed_25	Positive_Adjst_25	Negative_Adjst_25	QtySOH_25	Remark_25
26	Drug_26	caps	BeginningBal_26	QtyReceived_26	Qty_Dispensed_26	Positive_Adjst_26	Negative_Adjst_26	QtySOH_26	Remark_26
27	Drug_27	35ml	BeginningBal_27	QtyReceived_27	Qty_Dispensed_27	Positive_Adjst_27	Negative_Adjst_27	QtySOH_27	Remark_27
28	Drug_28	30ml	BeginningBal_28	QtyReceived_28	Qty_Dispensed_28	Positive_Adjst_28	Negative_Adjst_28	QtySOH_28	Remark_28
OTHER ARVS
29	Drug_29		BeginningBal_29	QtyReceived_29	Qty_Dispensed_29	Positive_Adjst_29	Negative_Adjst_29	QtySOH_29	Remark_29
30	Drug_30		BeginningBal_30	QtyReceived_30	Qty_Dispensed_30	Positive_Adjst_30	Negative_Adjst_30	QtySOH_30	Remark_30
31	Drug_31		BeginningBal_31	QtyReceived_31	Qty_Dispensed_31	Positive_Adjst_31	Negative_Adjst_31	QtySOH_31	Remark_31

Please provide details (expiry dates, lot numbers & quantities) of any commodity that will expire in six months time and any other information
Description	LotNo	Expiry Date	Quantity
Drug_32	lotNo_32	expirydate_32	Qty_expired_32
Drug_33	lotNo_33	expirydate_33	Qty_expired_33
Drug_34	lotNo_34	expirydate_34	Qty_expired_34

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