{BEGIN container_all}
{END container_all}
{BEGIN container_edit}
{BEGIN editheader}
{END editheader}{BEGIN message_block}
{END message_block}
{END container_edit}{$pagetitlelabel viral_load edit}
{BEGIN container_fields}
{BEGIN Downtime_12_fieldblock}
{BEGIN editbuttons}{END editbuttons}{END container_fields}
|
COMBINED REPORT, REQUISITION, ISSUE AND RECEIPT FORM (CRRIRF) - Lab Reagents/Accessories POLYMERASE CHAIN REACTION (PCR) |
| SiteName | {$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 | {$IPName_editcontrol} | ||
|
| |||||
| S/No | Item Description | Reporting Unit |
Beginning Balance (for the reporting period) |
Qty Received (In the reporting period) |
Qty Used (in the reporting period) |
Positive_Adjust | Negative_Adjust |
Physical Count (at end of reporting period) |
Remarks |
| PCR MACHINE (ROCHE) | |||||||||
| 1 | {$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} | {$Remark_7_editcontrol} | |
| 8 | {$Drug_8_editcontrol} | {$BeginningBal_8_editcontrol} | {$QtyReceived_8_editcontrol} | {$Qty_Dispensed_8_editcontrol} | {$Positive_Adjst_8_editcontrol} | {$Negative_Adjst_8_editcontrol} | {$QtySOH_8_editcontrol} | {$Remark_8_editcontrol} | |
| 9 | {$Drug_9_editcontrol} | {$BeginningBal_9_editcontrol} | {$QtyReceived_9_editcontrol} | {$Qty_Dispensed_9_editcontrol} | {$Positive_Adjst_9_editcontrol} | {$Negative_Adjst_9_editcontrol} | {$QtySOH_9_editcontrol} | {$Remark_9_editcontrol} | |
| BIMONTHLY TEST SUMMARY OF EARLY INFANT DIAGNOSIS (EID) and VIRAL LOAD | EXPIRY DETAILS: EXPIRED AND SHORT DATED ITEMS | ||||
| MONTH 1 | MONTH2 | Please provide
details(expiry dates, lot numbers & quantities) of any commodity that will expire within two(2) months | |||
| Description | Expiry Date | Quantity | |||
| {$Drug_10_editcontrol} | {$month1_10_editcontrol} | {$month2_10_editcontrol} | {$desc_10_editcontrol} | {$expiryDate_10_editcontrol} | {$expiryQty_10_editcontrol} |
| {$Drug_11_editcontrol} | {$month1_11_editcontrol} | {$month2_11_editcontrol} | {$desc_11_editcontrol} | {$expiryDate_11_editcontrol} | {$expiryQty_11_editcontrol} |
| {$Drug_12_editcontrol} | {$Downtime_12_editcontrol} | ||||
| {BEGIN Downtime_12_label}{END Downtime_12_label} |