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{BEGIN editheader}
{END editheader}{BEGIN message_block}
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{END container_edit}{$pagetitlelabel rtkcrrifs edit}
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{BEGIN ValidateEntry_fieldblock}
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|
COMBINED REPORT, REQUISITION, ISSUE AND RECEIPT FORM (CRRIRF) -
Lab Reagents/Accesories |
| SiteName | {$SiteName_editcontrol} |
Data Entry Consultant Name {$ValidateEntry_editcontrol} | |||
| Facility Code | {$formid_editcontrol} | Fundind Source | {$Funding_Source_editcontrol} |  | |
| State | {$State_editcontrol} | Service Type | {$Service_Type_editcontrol} | ||
| Phase | {$Phase_editcontrol} | IPName | {$IPName_editcontrol} | ||
| S/No | Item Description | Reporting Unit | Beginning Balance (In Reporting Unit) |
Qty Received (In Reporting Unit) |
Qty Used (In Reporting Unit) |
Positive Adjust. | Negative Adjust. |
Physical Count (at end of Reporting Period) |
Remarks |
| HIV RTKS | |||||||||
| 1 | {$Drug_1_editcontrol} | 100 | {$BeginningBal_1_editcontrol} | {$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} | 20 | {$BeginningBal_2_editcontrol} | {$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} | 20 | {$BeginningBal_3_editcontrol} | {$QtyReceived_3_editcontrol} | {$Qty_Dispensed__editcontrol} | {$Positive_Adjst_3_editcontrol} | {$Negative_Adjst_3_editcontrol} | {$QtySOH_3_editcontrol} | {$Remark_3_editcontrol} |
| 5 | {$Drug_5_editcontrol} | 20 | {$BeginningBal_5_editcontrol} | {$QtyReceived_5_editcontrol} | {$Qty_Dispensed_5_editcontrol} | {$Positive_Adjst_5_editcontrol} | {$Negative_Adjst_5_editcontrol} | {$QtySOH_5_editcontrol} | {$Remark_5_editcontrol} |
| DBS TEST OLLECTION KITS | |||||||||
| 1 | {$Drug_7_editcontrol} | 20 | {$BeginningBal_7_editcontrol} | {$QtyReceived_7_editcontrol} | {$Qty_Dispensed_7_editcontrol} | {$Positive_Adjst_7_editcontrol} | {$Negative_Adjst_7_editcontrol} | {$QtySOH_7_editcontrol} | {$Remark_7_editcontrol} |
| 2 | {$Drug_8_editcontrol} | 50 | {$BeginningBal_8_editcontrol} | {$QtyReceived_8_editcontrol} | {$Qty_Dispensed_8_editcontrol} | {$Positive_Adjst_8_editcontrol} | {$Negative_Adjst_8_editcontrol} | {$QtySOH_8_editcontrol} | {$Remark_8_editcontrol} |
| BIMONTHLY TEST SUMMARY OF HIV TESTING & EARLY INFANT DIAGNOSIS (EID) | ||||||||
| S/No | Description | HTC | PMTCT | CLINICAL DIAGNOSIS | QUALITY CONTROL | TRAINING | RECRUIT/OUTREACH SCREENING | TOTAL |
| 1 | {$Drug_9_editcontrol} | {$HTC_9_editcontrol} | {$PMTCT_9_editcontrol} | {$DIAGNOSIS_9_editcontrol} | {$Quality_control_9_editcontrol} | {$training_9_editcontrol} | {$outreach_9_editcontrol} | {$total_9_editcontrol} |
| 2 | {$Drug_10_editcontrol} | {$HTC_10_editcontrol} | {$PMTCT_10_editcontrol} | {$DIAGNOSIS_10_editcontrol} | {$Quality_control_10_editcontrol} | {$training_10_editcontrol} | {$outreach_10_editcontrol} | {$total_10_editcontrol} |
| 3 | {$Drug_11_editcontrol} | {$HTC_11_editcontrol} | {$PMTCT_11_editcontrol} | {$DIAGNOSIS_11_editcontrol} | {$Quality_control_11_editcontrol} | {$training_11_editcontrol} | {$outreach_11_editcontrol} | {$total_11_editcontrol} |
|
BIMONTHLY TEST SUMMARY OF HIV TESTING & EARLY INFANT DIAGNOSIS (EID) | |
|
HIV TESTING | |
| Number of people tested | {$NumberTested_editcontrol} |
| Number of people who received counselling and testing and got result (HCT, PMTCT, TB/HIV combined) | {$NumberTestgotResult_editcontrol} |
| Number of people tested with positive results (HCT, PMTCT, TB/HIV combined) | {$NumberTestedPositive_editcontrol} |
|
EID TESTING | |
| Number of HIV exposed babies | {$NumberHIVExposedBabies_editcontrol} |
| Number of infants received EID testing | {$NumberInfantgotEID_editcontrol} |
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