Rtkcrrifs, Edit record [Formid:formid]
formid
]|
COMBINED REPORT, REQUISITION, ISSUE AND RECEIPT FORM (CRRIRF) -
Lab Reagents/Accesories |
| SiteName |
SiteName |
Data Entry Consultant Name
ValidateEntry | |||
| Facility Code |
formid |
Fundind Source |
Funding_Source |
 | |
| State |
State |
Service Type |
Service_Type | ||
| Phase |
Phase |
IPName |
IPName | ||
| S/No | Item Description | Reporting Unit | Beginning Balance (In Reporting Unit) |
Qty Received (In Reporting Unit) |
Qty Used (In Reporting Unit) |
Positive Adjust. | Negative Adjust. |
Physical Count (at end of Reporting Period) |
Remarks |
| HIV RTKS | |||||||||
| 1 |
Drug_1 |
100 |
BeginningBal_1 |
QtyReceived_1 |
Qty_Dispensed_1
|
Positive_Adjst_1 |
Negative_Adjst_1 |
QtySOH_1 |
Remark_1 |
| 2 |
Drug_2 |
20 |
BeginningBal_2 |
QtyReceived_2 |
Qty_Dispensed_2
|
Positive_Adjst_2 |
Negative_Adjst_2 |
QtySOH_2 |
Remark_2 |
| 3 |
Drug_3 |
20 |
BeginningBal_3 |
QtyReceived_3 |
Qty_Dispensed_ |
Positive_Adjst_3 |
Negative_Adjst_3 |
QtySOH_3 |
Remark_3 |
| 5 |
Drug_5 |
20 |
BeginningBal_5 |
QtyReceived_5 |
Qty_Dispensed_5
|
Positive_Adjst_5 |
Negative_Adjst_5 |
QtySOH_5 |
Remark_5 |
| DBS TEST OLLECTION KITS | |||||||||
| 1 |
Drug_7 |
20 |
BeginningBal_7 |
QtyReceived_7 |
Qty_Dispensed_7
|
Positive_Adjst_7 |
Negative_Adjst_7 |
QtySOH_7 |
Remark_7 |
| 2 |
Drug_8 |
50 |
BeginningBal_8 |
QtyReceived_8 |
Qty_Dispensed_8
|
Positive_Adjst_8 |
Negative_Adjst_8 |
QtySOH_8 |
Remark_8 |
| BIMONTHLY TEST SUMMARY OF HIV TESTING & EARLY INFANT DIAGNOSIS (EID) | ||||||||
| S/No | Description | HTC | PMTCT | CLINICAL DIAGNOSIS | QUALITY CONTROL | TRAINING | RECRUIT/OUTREACH SCREENING | TOTAL |
| 1 |
Drug_9 |
HTC_9 |
PMTCT_9 |
DIAGNOSIS_9 |
Quality_control_9 |
training_9 |
outreach_9 |
total_9 |
| 2 |
Drug_10 |
HTC_10 |
PMTCT_11 |
DIAGNOSIS_10 |
Quality_control_10 |
training_10 |
outreach_10 |
total_10 |
| 3 |
Drug_11 |
HTC_11 |
PMTCT_11 |
DIAGNOSIS_11 |
Quality_control_11 |
training_11 |
outreach_11 |
total_11 |
|
BIMONTHLY TEST SUMMARY OF HIV TESTING & EARLY INFANT DIAGNOSIS (EID) | |
|
HIV TESTING | |
| Number of people tested |
NumberTested |
| Number of people who received counselling and testing and got result (HCT, PMTCT, TB/HIV combined) |
NumberTestgotResult
|
| Number of people tested with positive results (HCT, PMTCT, TB/HIV combined) |
NumberTestedPositive
|
|
EID TESTING | |
| Number of HIV exposed babies |
NumberHIVExposedBabies
|
| Number of infants received EID testing |
NumberInfantgotEID |