drug utilization form

8/16/2019 Drug Utilization Form

http://slidepdf.com/reader/full/drug-utilization-form 1/4

Republic of the Philippines

DEPARTMENT OF HEALTH

Field Operations

Regional Health Office No.

OFF!"E OF THE R#RAL HEALTH PH$%!"!AN

Pulupandan& Negros Occidental

RH# DR#' #T!L!(AT!ON)%TO"*% !N+ENTOR$ REPORT

For the DOH "o,plete Treat,ent Pac- Progra,

RHU PULUPANDANAddress: Riego Street Brgy. Zone 4, Pulupandan Year:

!"#$ %uarter: #st %UAR&'R

Region: () Medicines Ending

Balance of

Previous

Quarter

Delivery

Date

Quanti

ty

Delive

red

(Packs

)

Beginnin

g

Balance

Number of DOH om!acks dis!ensed

(!er mont")

#otal

Number of

DOH

om!acks

dis!ensed

End of

Quarter

$tocksM%&H

*L)+LAZ)D' "-* &AB $! $! / / /00H+&Z !/ -* 00 000 0/ 0/ !

'RY&HR1-Y+)N /"" -* +AP 4"" 4"" !/ !/ 02/-'&1PR1L1L /"-* &AB !4! 03#23#$ /! !4 #2/ #2/ $4'NALAPR)L #" -* &AB #!! #!! ! ! 4"

+1&R)-1AZ1L' ""3#$"-* 4" 4" 04 04 $D1Y+Y+L)N' #"" -* +AP !$/ !$/ !" !" !4/-'&R1N)DAZ1L' /""-* 0## 0## #" #" 0"#A-L1D)P)N' #"-* &AB 4/ RHU BA*1 +)&Y

!!3#$!"" $/ /!! /!! #20

S)-(AS&A&)N !"-* &AB 220 220 4!! 4!! 0/#+1&R)-1AZ1L' !""3 4"-*

SUSP." " " " "

+1&R)-1AZ1L' 4""3"-*SUSP.

$2 $/ $/ 0

+L1A+)LL)N #!/ -* SUSP. $0 $0 !4 !4 0ASP)R)N "-* &AB #0# #0# !/ !/ #"$

SALBU&A-1L #"" -+* " " " " "+L1A+)LL)N /"" -* " " " " "

L1SAR&AN /! RHU BA*1 +)&Y!!3#$

!"" 2! /0# /0# #



-'&51R-)N /"" -* &AB /# /# #"$ #"$ 4#0

Prepared By: Noted By: Appro6ed By:

-A. LALA)N' &. -)RA(ALL'S DR. *RA+' *. D' 7UAN, -.D. H1-)*U'L +. P'8A

SUPPLY )N+HAR*'D -uni9ipal Healt 1;9er -uni9ipal -ayor

Republic of the PhilippinesDEPARTMENT OF HEALTH

Field Operations






RHU PULUPANDANAddress: Riego Street Brgy. Zone 4, Pulupandan Year: !"#$

%uarter: #S& %UAR&'R


Balance of

Previous

Quarter

Deliver

y Date

Quantity

Delivere

d

(Packs)

Beginnin

g

Balance


(!er mont")

#otal

Number of

DOH

om!acks

dis!ensed

End of

Quarter

$tocksM%&H

*L)B'N+LA-)D' /-* &AB ! ! ! "A-1)+)LL)N /"" -* +APS " " " " " "A-1)+)LL)N !/" -* SUSP. #04 /2 /2 22

+)PR15L1A+)N /"" -* &AB 40# 40# !/ !/ 4"$LA*UND) 0"" -* &AB #2" #2" #2" #2" "SA-B1N* !/-* &AB #! #! 0 0

5LU&)+AS1N' < SAL-U&'R1L!/3/" -+*

00 00 !/ !/

5LU&)+AS1N' < SAL-U&'R1L!/-+*3#!/-+*

#" #" " " #"






Republic of the Philippines

DEPARTMENT OF HEALTH

Field Operations






RHU PULUPANDANAddress: Riego Street Brgy. Zone 4, Pulupandan Year: !"#$

%uarter: #S& %UAR&'R


Balance of

Previous

Quarter

Deliver

y Date

Quantity

Delivere

d

(Packs)

Beginnin

g

Balance


(!er mont")

#otal

Number of

DOH

om!acks

dis!ensed

End of

Quarter

$tocksM%&H

A-L1D)P)N' #" -* 02/ 02/ 02/ "L1SAR&AN /" -* 0!# 0!# 0!# "

-'&51R-)N 02/ /" /" 0!/

drug utilization form

Documents