CENTRAL PHARMACY STOCK REPORT FORM

ACTION CONTRE LA FAIM

ACF mission : Location:
Responsible
From: To: Date of reporting

Financial code Expiry date Project code

Valorisation Previous balance Quantity received Programme Funded by Programme Funded by Programme Funded by Programme Funded by

DELIVERIES PER DESTINATION Programme Funded by Programme Funded by Programme Funded by Programme Funded by Programme Funded by Programme Funded by

Designation (incuding concentration)

Packaging

Unit

Ctry

Donor

Bud.

Line

Unit Price

Cur.

Losses

Total OUT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Balance finale 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Inventory

Remarks

Designation of the drugs and materials

ACETYLSALICYLIC ACID TAB 300 MG ACETYLSALICYLIC ACID TAB 500 MG ALUMINIUM HYDROXIDE TAB 500 MG AMINOPHYLLINE 100 MG AMOXICILLIN 250 MG AMOXICILLIN 500 MG BUTYLSCOPOLAMINE 10 MG CHLORAMPHENICOL 250 MG CLOXACILLINE 250 MG COTRIMOXAZOLE 400 + 80 MG DOXYCYCLINE 100 MG FERROUS SULFATE + FOLIC ACID TAB 200 + 0,25 MG FOLIC ACID 5 MG FUROSEMIDE 40 MG MEBENDAZOLE TAB 100 MG METHYLDOPA 250 MG METRONIDAZOLE 250 MG MULTIVITAMIN TAB NYSTATIN 100000 UI NYSTATIN VAGINAL 100000 UI ORS Sachet For 1 litre PARACETAMOL TAB 100 MG PARACETAMOL TAB 500 MG PENICILLIN V 250 MG PREDNISOLONE 5 MG PROMETHAZINE 25 MG QUININE SULFATE 200 MG RETINOL ( VITAMINE A ) 200000 UI SALBUTAMOL 4 MG DRUGS-INJECTABLE ADRENALINE 1 MG / ML AMINOPHYLLINE 25 MG / ML AMPICILLIN 500 MG / VIAL ATROPINE 1 MG / ML BENZATHINE BENZYLPENICILLIN 1.2M UI BUTYLSCOPOLAMINE 20 MG / ML CHLORAMPHENICOL 1G / VIAL DEXAMETHAZONE 4MG / ML DIAZEPAM 5MG / ML ERGOMETRINE MALEATE 0.2 MG / ML FUROSEMIDE 10 MG / ML GENTAMYCIN 40MG/ML GLUCOSE 5% 500ML GLUCOSE 5% 1000ML GLUCOSE 50% 50ML HYDRALAZINE 20 MG / ML LIDOCAINE 0,01 PROMETHAZINE 25 MG / ML QUININE SULFATE 300 MG/ML RINGER LACTATE 500 ML RINGER LACTATE 1000 ML WATER FOR INJECTION 5 ML WATER FOR INJECTION 10 ML EXTERNAL USE BENZYL BENZOATE (LITRE) 25 % Lotion BENZOIC ACID +SALICYLIC ACID KG 6%+3% CALAMINE LOTION 500 ML 0,15 CHLOREXIDINE (LITRE) 0,05 GENTIAN VIOLET POWDER 25 G POLYVIDONE 200ML 0,1 TETRACYCLINE EYE OINTMENT 0,01 ZINC OXYDE KG 0,1 RENEWABLE SUPPLIES ABSORBANT COTTON WOOL KG ADHESIVE TAPE ROLL 2,5 cm x 5 m ELASTIC BANDAGE 'CREPE) 8 cm X 4 m GAUZE BANDAGE 7,5 cm X 10 m GAUZE COMPRESS Non STERILE 10 X 10 cm GAUZE COMPRESSE STERILE 10 X 10 cm GAUZE ROLL 90m X 0.90 m HANDLE FOR SURGICAL BLADE No 4 IV PLACEMENT UNIT 20G IV PLACEMENT UNIT 22G IV PLACEMENT UNIT 24G NEEDLE (DISPOSABLE) 19G NEEDLE (DISPOSABLE) 21G NEEDLE (DISPOSABLE) 23G NEEDLE (DISPOSABLE) 25G SCALP VEIN INFUSION SET 21G SCALP VEIN INFUSION SET 23G SURGICAL BLADE N 22 SURGICAL GLOVES STERILE N 6.5 SURGICAL GLOVES STERILE N 7.5 SURGICAL GLOVES STERILE N 8.5 SUTURE ABSORBABLE 2/00 SUTURE ABSORBABLE 3/00 SYRINGE DISPOSABLE 2 ML SYRINGE DISPOSABLE 5 ML SYRINGE DISPOSABLE 10 ML SYRINGE DISPOSABLE 20 ML THERMOMETRE ( oral / rectal ) TONGUE DEPRESSOR WOODEN

Note:

SYRINGE DISPOSABLE 20 ML

The objective of this list is to avoid spelling mistakes in the stock report. It contain the common drugs used on ACF programmes. The Medico-Nutritional Coordinator has to adapt this list to the mission.

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0