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COMBINED REPORT, REQUISITION, ISSUE AND RECEIPT FORM (CRRIRF) - Lab Reagents/Accesories CD4 REAGENTS |
| SiteName | {$SiteName_editcontrol} | ||||
| Facility Code | {$formid_editcontrol} | Funding Source | {$Funding_Source_editcontrol} |  |
Data Entry Consultant Name {$ValidateEntry_editcontrol}
|
| State | {$State_editcontrol} | Service Type | {$Service_Type_editcontrol} | ||
| Phase | {$Phase_editcontrol} | IPName | {$IPName_editcontrol} | ||
| S/No | Item Description | Reporting Unit |
Beginning Balance (for the reporting period) |
Qty Received (in the reporting period) |
Qty Used (in the reporting period) |
Positive-Adjust (in reporting period) |
Negative-Adjust (in reporting period) |
Physical Count (at end of reporting period) |
Remarks |
| BD FASCOUNT | |||||||||
| 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} | |
| 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} | |
| PARTEC CYFLOW REAGENTS | |||||||||
| 1 | {$Drug_8_editcontrol} | {$BeginningBal_8_editcontrol} | {$QtyReceived_8_editcontrol} | {$Qty_Dispensed_8_editcontrol} | {$Positive_Adjst_8_editcontrol} | {$Negative_Adjst_8_editcontrol} | {$QtySOH_8_editcontrol} | {$Remark_8_editcontrol} | |
| 2 | {$Drug_9_editcontrol} | {$BeginningBal_9_editcontrol} | {$QtyReceived_9_editcontrol} | {$Qty_Dispensed_9_editcontrol} | {$Positive_Adjst_9_editcontrol} | {$Negative_Adjst_9_editcontrol} | {$QtySOH_9_editcontrol} | {$Remark_9_editcontrol} | |
| 3 | {$Drug_10_editcontrol} | {$BeginningBal_10_editcontrol} | {$QtyReceived_10_editcontrol} | {$Qty_Dispensed_10_editcontrol} | {$Positive_Adjst_10_editcontrol} | {$Negative_Adjst_10_editcontrol} | {$QtySOH_10_editcontrol} | {$Remark_10_editcontrol} | |
| 4 | {$Drug_11_editcontrol} | {$BeginningBal_11_editcontrol} | {$QtyReceived_11_editcontrol} | {$Qty_Dispensed_11_editcontrol} | {$Positive_Adjst_11_editcontrol} | {$Negative_Adjst_11_editcontrol} | {$QtySOH_11_editcontrol} | {$Remark_11_editcontrol} | |
| 5 | {$Drug_12_editcontrol} | {$BeginningBal_12_editcontrol} | {$QtyReceived_12_editcontrol} | {$Qty_Dispensed_12_editcontrol} | {$Positive_Adjst_12_editcontrol} | {$Negative_Adjst_12_editcontrol} | {$QtySOH_12_editcontrol} | {$Remark_12_editcontrol} | |
| 6 | {$Drug_13_editcontrol} | {$BeginningBal_13_editcontrol} | {$QtyReceived_13_editcontrol} | {$Qty_Dispensed_13_editcontrol} | {$Positive_Adjst_13_editcontrol} | {$Negative_Adjst_13_editcontrol} | {$QtySOH_13_editcontrol} | {$Remark_13_editcontrol} | |
| 7 | {$Drug_14_editcontrol} | {$BeginningBal_14_editcontrol} | {$QtyReceived_14_editcontrol} | {$Qty_Dispensed_14_editcontrol} | {$Positive_Adjst_14_editcontrol} | {$Negative_Adjst_14_editcontrol} | {$QtySOH_14_editcontrol} | {$Remark_14_editcontrol} | |
| 8 | {$Drug_15_editcontrol} | {$BeginningBal_15_editcontrol} | {$QtyReceived_15_editcontrol} | {$Qty_Dispensed_15_editcontrol} | {$Positive_Adjst_15_editcontrol} | {$Negative_Adjst_15_editcontrol} | {$QtySOH_15_editcontrol} | {$Remark_15_editcontrol} | |
| POINT OF CARE CD4 DEVICE (PIMA) | |||||||||
| 1 | {$Drug_16_editcontrol} | {$BeginningBal_16_editcontrol} | {$QtyReceived_16_editcontrol} | {$Qty_Dispensed_16_editcontrol} | {$Positive_Adjst_16_editcontrol} | {$Negative_Adjst_16_editcontrol} | {$QtySOH_16_editcontrol} | {$Remark_16_editcontrol} | |
| 2 | {$Drug_17_editcontrol} | {$BeginningBal_17_editcontrol} | {$QtyReceived_17_editcontrol} | {$Qty_Dispensed_17_editcontrol} | {$Positive_Adjst_17_editcontrol} | {$Negative_Adjst_17_editcontrol} | {$QtySOH_17_editcontrol} | {$Remark_17_editcontrol} | |
| 3 | {$Drug_18_editcontrol} | {$BeginningBal_18_editcontrol} | {$QtyReceived_18_editcontrol} | {$Qty_Dispensed_18_editcontrol} | {$Positive_Adjst_18_editcontrol} | {$Negative_Adjst_18_editcontrol} | {$QtySOH_18_editcontrol} | {$Remark_18_editcontrol} | |
| 4 | {$Drug_19_editcontrol} | {$BeginningBal_19_editcontrol} | {$QtyReceived_19_editcontrol} | {$Qty_Dispensed_19_editcontrol} | {$Positive_Adjst_19_editcontrol} | {$Negative_Adjst_19_editcontrol} | {$QtySOH_19_editcontrol} | {$Remark_19_editcontrol} | |
| EQUIPMENT DOWNTIME WITHIN THE REPORTING PERIOD | |||||||||
| No. of Days | |||||||||
| 1 | {$Drug_20_editcontrol} | {$BeginningBal_20_editcontrol} | |||||||
| 2 | {$Drug_21_editcontrol} | {$BeginningBal_21_editcontrol} | |||||||
| 3 | {$Drug_22_editcontrol} | {$BeginningBal_22_editcontrol} | |||||||