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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	Quantity Received during Reporting Period	Quantity Dispensed During Reporting Period	Ending Balance (Physical Count)	Remarks
ARV FOR PREGNANT MOTHERS
1	Drug_1	60 tabs	QtyReceived_1	Qty_Dispensed_1	QtySOH_1	Remark_1
5	Drug_5	30 tabs	QtyReceived_5	Qty_Dispensed_5	QtySOH_5	Remark_5
ARV FOR EXPOSED BABIES
17	Drug_17	30 tabs	QtyReceived_17	Qty_Dispensed_17	QtySOH_17	Remark_17
18	Drug_18	25ml	QtyReceived_18	Qty_Dispensed_18	QtySOH_18	Remark_18
19	Drug_19	100ml	QtyReceived_19	Qty_Dispensed_19	QtySOH_19	Remark_19
OPPORTUNISTICS INFECTIOUS DRUGS
22	Drug_22	tabs	QtyReceived_22	Qty_Dispensed_22	QtySOH_22	Remark_22
23	Drug_23	tabs	QtyReceived_23	Qty_Dispensed_23	QtySOH_23	Remark_23
24	Drug_24	tabs	QtyReceived_24	Qty_Dispensed_24	QtySOH_24	Remark_24
OTHER ARVS
29	Drug_29		QtyReceived_29	Qty_Dispensed_29	QtySOH_29	Remark_29
30	Drug_30		QtyReceived_30	Qty_Dispensed_30	QtySOH_30	Remark_30
31	Drug_31		QtyReceived_31	Qty_Dispensed_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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