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

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SiteName {$SiteName_editcontrol}       coat of arms         Data Consultant Name{$ValidateEntry_editcontrol}
 Facility Code {$formid_editcontrol}  Funding Source {$Funding_Source_editcontrol}
 State {$State_editcontrol}  Service Type {$Service_Type_editcontrol}
 Phase {$Phase_editcontrol}  IPName {$IPName_editcontrol}
       
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 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 {$Drug_1_editcontrol}   {$BeginningBal_1_editcontrol} {$QtyReceived_1_editcontrol} {$Qty_Dispensed_1_editcontrol} {$Positive_Adjst_1_editcontrol} {$Negative_Adjst_1_editcontrol} {$QtySOH_1_editcontrol} {$Remark_1_editcontrol}
 2 {$Drug_2_editcontrol}   {$BeginningBal_2_editcontrol} {$QtyReceived_2_editcontrol} {$Qty_Dispensed_2_editcontrol} {$Positive_Adjst_2_editcontrol} {$Negative_Adjst_2_editcontrol} {$QtySOH_2_editcontrol} {$Remark_2_editcontrol}
 3 {$Drug_3_editcontrol}   {$BeginningBal_3_editcontrol} {$QtyReceived_3_editcontrol} {$Qty_Dispensed__editcontrol} {$Positive_Adjst_3_editcontrol} {$Negative_Adjst_3_editcontrol} {$QtySOH_3_editcontrol} {$Remark_3_editcontrol}
 4 {$Drug_4_editcontrol} {$BeginningBal_4_editcontrol} {$QtyReceived_4_editcontrol} {$Qty_Dispensed_4_editcontrol} {$Positive_Adjst_4_editcontrol} {$Negative_Adjst_4_editcontrol} {$QtySOH_4_editcontrol} {$Remark_4_editcontrol}
 5 {$Drug_5_editcontrol} {$BeginningBal_5_editcontrol} {$QtyReceived_5_editcontrol} {$Qty_Dispensed_5_editcontrol} {$Positive_Adjst_5_editcontrol} {$Negative_Adjst_5_editcontrol} {$QtySOH_5_editcontrol} {$Remark_5_editcontrol}
SINGLE DOSE ADULT FIRST LINE
 6 {$Drug_6_editcontrol} {$BeginningBal_6_editcontrol} {$QtyReceived_6_editcontrol} {$Qty_Dispensed_6_editcontrol} {$Positive_Adjst_6_editcontrol} {$Negative_Adjst_6_editcontrol} {$QtySOH_6_editcontrol} {$Remark_6_editcontrol}
 7 {$Drug_7_editcontrol} {$BeginningBal_7_editcontrol} {$QtyReceived_7_editcontrol} {$Qty_Dispensed_7_editcontrol} {$Positive_Adjst_7_editcontrol} {$Negative_Adjst_7_editcontrol} {$QtySOH_7_editcontrol} {$Remark_7_editcontrol}
 8 {$Drug_8_editcontrol} {$BeginningBal_8_editcontrol} {$QtyReceived_8_editcontrol} {$Qty_Dispensed_8_editcontrol} {$Positive_Adjst_8_editcontrol} {$Negative_Adjst_8_editcontrol} {$QtySOH_8_editcontrol} {$Remark_8_editcontrol}
ADULT SECOND LINE DRUGS
 9 {$Drug_9_editcontrol} {$BeginningBal_9_editcontrol} {$QtyReceived_9_editcontrol} {$Qty_Dispensed_9_editcontrol} {$Positive_Adjst_9_editcontrol} {$Negative_Adjst_9_editcontrol} {$QtySOH_9_editcontrol} {$Remark_9_editcontrol}
 10 {$Drug_10_editcontrol} {$BeginningBal_10_editcontrol} {$QtyReceived_10_editcontrol} {$Qty_Dispensed_10_editcontrol} {$Positive_Adjst_10_editcontrol} {$Negative_Adjst_10_editcontrol} {$QtySOH_10_editcontrol} {$Remark_10_editcontrol}
PEDIATRIC FIXED DOSE COMBINATION
 11 {$Drug_11_editcontrol} {$BeginningBal_11_editcontrol} {$QtyReceived_11_editcontrol} {$Qty_Dispensed_11_editcontrol} {$Positive_Adjst_11_editcontrol} {$Negative_Adjst_11_editcontrol} {$QtySOH_11_editcontrol} {$Remark_11_editcontrol}
 12 {$Drug_12_editcontrol} {$BeginningBal_12_editcontrol} {$QtyReceived_12_editcontrol} {$Qty_Dispensed_12_editcontrol} {$Positive_Adjst_12_editcontrol} {$Negative_Adjst_12_editcontrol} {$QtySOH_12_editcontrol} {$Remark_12_editcontrol}
 13 {$Drug_13_editcontrol} {$BeginningBal_13_editcontrol} {$QtyReceived_13_editcontrol} {$Qty_Dispensed_13_editcontrol} {$Positive_Adjst_13_editcontrol} {$Negative_Adjst_13_editcontrol} {$QtySOH_13_editcontrol} {$Remark_13_editcontrol}
 14 {$Drug_14_editcontrol} {$BeginningBal_14_editcontrol} {$QtyReceived_14_editcontrol} {$Qty_Dispensed_14_editcontrol} {$Positive_Adjst_14_editcontrol} {$Negative_Adjst_14_editcontrol} {$QtySOH_14_editcontrol} {$Remark_14_editcontrol}
PEDIATRIC SINGLE DOSE
 15 {$Drug_15_editcontrol} {$BeginningBal_15_editcontrol} {$QtyReceived_15_editcontrol} {$Qty_Dispensed_15_editcontrol} {$Positive_Adjst_15_editcontrol} {$Negative_Adjst_15_editcontrol} {$QtySOH_15_editcontrol} {$Remark_15_editcontrol}
 16 {$Drug_16_editcontrol} {$BeginningBal_16_editcontrol} {$QtyReceived_16_editcontrol} {$Qty_Dispensed_16_editcontrol} {$Positive_Adjst_16_editcontrol} {$Negative_Adjst_16_editcontrol} {$QtySOH_16_editcontrol} {$Remark_16_editcontrol}
 17 {$Drug_17_editcontrol} {$BeginningBal_17_editcontrol} {$QtyReceived_17_editcontrol} {$Qty_Dispensed_17_editcontrol} {$Positive_Adjst_17_editcontrol} {$Negative_Adjst_17_editcontrol} {$QtySOH_17_editcontrol} {$Remark_17_editcontrol}
 18 {$Drug_18_editcontrol} {$BeginningBal_18_editcontrol} {$QtyReceived_18_editcontrol} {$Qty_Dispensed_18_editcontrol} {$Positive_Adjst_18_editcontrol} {$Negative_Adjst_18_editcontrol} {$QtySOH_18_editcontrol} {$Remark_18_editcontrol}
 19 {$Drug_19_editcontrol} {$BeginningBal_19_editcontrol} {$QtyReceived_19_editcontrol} {$Qty_Dispensed_19_editcontrol} {$Positive_Adjst_19_editcontrol} {$Negative_Adjst_19_editcontrol} {$QtySOH_19_editcontrol} {$Remark_19_editcontrol}
PEDIATRIC SECOND LINE DRUGS
 20 {$Drug_20_editcontrol} {$BeginningBal_20_editcontrol} {$QtyReceived_20_editcontrol} {$Qty_Dispensed_20_editcontrol} {$Positive_Adjst_20_editcontrol} {$Negative_Adjst_20_editcontrol} {$QtySOH_20_editcontrol} {$Remark_20_editcontrol}
 21 {$Drug_21_editcontrol} {$BeginningBal_21_editcontrol} {$QtyReceived_21_editcontrol} {$Qty_Dispensed_21_editcontrol} {$Positive_Adjst_21_editcontrol} {$Negative_Adjst_21_editcontrol} {$QtySOH_21_editcontrol} {$Remark_21_editcontrol}
OPPORTUNISTICS INFECTIOUS DRUGS
 22 {$Drug_22_editcontrol} {$BeginningBal_22_editcontrol} {$QtyReceived_22_editcontrol} {$Qty_Dispensed_22_editcontrol} {$Positive_Adjst_22_editcontrol} {$Negative_Adjst_22_editcontrol} {$QtySOH_22_editcontrol} {$Remark_22_editcontrol}
 23 {$Drug_23_editcontrol} {$BeginningBal_23_editcontrol} {$QtyReceived_23_editcontrol} {$Qty_Dispensed_23_editcontrol} {$Positive_Adjst_23_editcontrol} {$Negative_Adjst_24_editcontrol} {$QtySOH_23_editcontrol} {$Remark_23_editcontrol}
 24 {$Drug_24_editcontrol} {$BeginningBal_24_editcontrol} {$QtyReceived_24_editcontrol} {$Qty_Dispensed_24_editcontrol} {$Positive_Adjst_24_editcontrol} {$Negative_Adjst_24_editcontrol} {$QtySOH_24_editcontrol} {$Remark_24_editcontrol}
 25 {$Drug_25_editcontrol} {$BeginningBal_25_editcontrol} {$QtyReceived_25_editcontrol} {$Qty_Dispensed_25_editcontrol} {$Positive_Adjst_25_editcontrol} {$Negative_Adjst_25_editcontrol} {$QtySOH_25_editcontrol} {$Remark_25_editcontrol}
 26 {$Drug_26_editcontrol} {$BeginningBal_26_editcontrol} {$QtyReceived_26_editcontrol} {$Qty_Dispensed_26_editcontrol} {$Positive_Adjst_26_editcontrol} {$Negative_Adjst_26_editcontrol} {$QtySOH_26_editcontrol} {$Remark_26_editcontrol}
 27 {$Drug_27_editcontrol} {$BeginningBal_27_editcontrol} {$QtyReceived_27_editcontrol} {$Qty_Dispensed_27_editcontrol} {$Positive_Adjst_27_editcontrol} {$Negative_Adjst_27_editcontrol} {$QtySOH_27_editcontrol} {$Remark_27_editcontrol}
 28 {$Drug_28_editcontrol} {$BeginningBal_28_editcontrol} {$QtyReceived_28_editcontrol} {$Qty_Dispensed_28_editcontrol} {$Positive_Adjst_28_editcontrol} {$Negative_Adjst_28_editcontrol} {$QtySOH_28_editcontrol} {$Remark_28_editcontrol}
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