Family Planning

NAME OF RHU/CHO DULONG BAYAN
DATES COVERED JANUARY-MARCH 2016

DATE ACCOMPLISHED
QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

A B C D F G H I J
Stock Available/ Transfers Transfers Current

Commodity Unit Beginning Balance Quantity Received (received Quantity dispensed to clients at Losses (issued to stock/ Commodity requirements f
at from other C/MHO/RHU/BHS other Ending next quarter
C/MHO/RHU/BHS C/MHO) C/MHO) balance
Central Others Month 1 Month 2 Month 3 Total CR NR

Office
B+C+D-F- =F
G-H
COC cycle 0 400 100 0 60 40 40 140 0 0 360 140 0
POP cycle 0 0 0 0 0 0 0 0 0 0 0 0 0
DMPA vial 0 50 100 0 15 25 15 55 0 0 95 55 0
IUD piece 0 0 0 0 0 0 0 0 0 0 0 0
Implant piece 0 0 0 0 0 0 0 0 0 0 0 0
Condom piece 0 120 100 0 36 36 36 108 0 0 112 108 0
0 0 0
0 0 0
0 0 0
0 0 0
PREPARED BY: DESIGNATION:
CONTACT NUMBER: EMAIL:
APPROVED BY: DATE:
L M
uirements for Request/ Remarks

uarter Order
TOTAL
CR+NR J-I
140 -220
0 0
55 -40
0 0
0 0
108 -4
0 0
0 0
0 0
0 0
NAME OF RHU/CHO GUIJO
DATE ACCOMPLISHED

A B C D F G H I J


Office
B+C+D-F- =F
G-H
COC cycle 90 150 0 90 50 40 180 0 0 60 180 0
POP cycle 0 0 0 0 0 0 0 0 0 0 0 0
DMPA vial 25 50 0 25 15 10 50 0 0 25 50 0
IUD piece 0 0 0 0 0 0 0 0 0 0 0
Implant piece 0 0 0 0 0 0 0 0 0 0 0
Condom piece 122 120 0 63 42 45 150 0 0 92 150 86
0 0 0
0 0 0
0 0 0
0 0 0
APPROVED BY: DATE:
L M

uarter Order
TOTAL
CR+NR J-I
180 120
0 0
50 25
0 0
0 0
236 144
0 0
0 0
0 0
0 0
NAME OF RHU/CHO MULAWIN
DATE ACCOMPLISHED

A B C D F G H I J


Office
B+C+D-F- =F
G-H
COC cycle 72 210 0 0 35 28 20 83 0 0 199 83 0
POP cycle 0 0 0 0 0 0 0 0 0 0 0 0 0
DMPA vial 100 0 0 0 8 7 35 50 0 0 50 50 0
IUD piece 0 0 0 0 0 0 0 0 0 0 0 0
Implant piece 0 0 0 6 0 0 0 0 0 0 6 0
Condom piece 54 0 0 0 12 18 10 40 0 0 14 40 118
0 0 0
0 0 0
0 0 0
0 0 0
APPROVED BY: DATE:
L M

uarter Order
TOTAL
CR+NR J-I
83 -116
0 0
50 0
0 0
0 -6
158 144
0 0
0 0
0 0
0 0
NAME OF RHU/CHO NARRA
DATE ACCOMPLISHED

A B C D F G H I J


Office
B+C+D-F- =F
G-H
COC cycle 133 0 0 30 24 0 54 0 0 79 54 0
POP cycle 0 0 0 0 0 0 0 0 0 0 0 0
DMPA vial 57 0 0 10 12 0 22 0 0 35 22 0
IUD piece 0 0 0 0 0 0 0 0 0 0 0
Implant piece 0 0 0 0 0 0 0 0 0 0 0
Condom piece 12 0 0 3 2 0 5 0 0 7 5 0
0 0 0
0 0 0
0 0 0
0 0 0
APPROVED BY: DATE:
L M

uarter Order
TOTAL
CR+NR J-I
54 -25
0 0
22 -13
0 0
0 0
5 -2
0 0
0 0
0 0
0 0
NAME OF RHU/CHO POBLACION
DATE ACCOMPLISHED

A B C D F G H I J


Office
B+C+D-F- =F
G-H
COC cycle 92 120 0 0 30 35 30 95 0 0 117 95 0
POP cycle 0 0 0 0 0 0 0 0 0 0 0 0 0
DMPA vial 37 50 0 0 20 10 22 52 0 0 35 52 8
IUD piece 0 0 0 0 0 0 0 0 0 0 0 0
Implant piece 0 0 0 0 0 0 0 0 0 0 0 0
Condom piece 122 240 0 0 60 55 72 187 0 0 175 187 132
0 0 0
0 0 0
0 0 0
0 0 0
APPROVED BY: DATE:
L M

uarter Order
TOTAL
CR+NR J-I
95 -22
0 0
60 25
0 0
0 0
319 144
0 0
0 0
0 0
0 0
NAME OF RHU/CHO POBLACION I
DATE ACCOMPLISHED

A B C D F G H I J


Office
B+C+D-F- =F
G-H
COC cycle 140 120 0 0 64 55 45 164 0 0 96 164 22
POP cycle 0 0 0 0 0 0 0 0 0 0 0 0 0
DMPA vial 50 50 0 0 20 15 15 50 0 0 50 50 0
IUD piece 0 0 0 0 0 0 0 0 0 0 0 0
Implant piece 0 0 0 0 0 0 0 0 0 0 0 0
Condom piece 250 240 0 0 109 103 60 272 0 0 218 272 90
0 0 0
0 0 0
0 0 0
0 0 0
APPROVED BY: DATE:
L M

uarter Order
TOTAL
CR+NR J-I
186 90
0 0
50 0
0 0
0 0
362 144
0 0
0 0
0 0
0 0
NAME OF RHU/CHO SAPANG PALAY PROPER
DATE ACCOMPLISHED

A B C D F G H I J


Office
B+C+D-F- =F
G-H
COC cycle 90 400 0 0 40 50 132 222 0 0 268 222 0
POP cycle 50 0 0 0 0 0 0 0 0 0 50 0 0
DMPA vial 15 25 0 0 10 11 12 33 0 0 7 33 0
IUD piece 0 0 0 0 0 0 0 0 0 0 0 0
Implant piece 0 0 0 0 0 0 0 0 0 0 0 0
Condom piece 6 120 0 0 8 8 12 28 0 0 98 28 0
0 0 0
0 0 0
0 0 0
0 0 0
APPROVED BY: DATE:
L M

uarter Order
TOTAL
CR+NR J-I
222 -46
0 -50
33 26
0 0
0 0
28 -70
0 0
0 0
0 0
0 0
NAME OF RHU/CHO YAKAL
DATE ACCOMPLISHED

A B C D F G H I J


Office
B+C+D-F- =F
G-H
COC cycle 34 0 0 0 11 12 11 34 0 0 0 34 26
POP cycle 0 0 0 0 0 0 0 0 0 0 0 0 0
DMPA vial 5 0 0 0 10 10 7 27 0 0 -22 27 1
IUD piece 0 0 0 0 0 0 0 0 0 0 0 0
Implant piece 0 0 0 0 0 0 0 0 0 0 0 0
Condom piece 24 0 0 0 22 22 20 64 0 0 -40 64 40
0 0 0
0 0 0
0 0 0
0 0 0
APPROVED BY: DATE:
L M

uarter Order
TOTAL
CR+NR J-I
60 60
0 0
28 50
0 0
0 0
104 144
0 0
0 0
0 0
0 0
DATE ACCOMPLISHED

A B C D F G H I J


Office
B+C+D-F- =F
G-H
COC cycle 1566 1890 100 0 594 527 562 1683 0 0 1873 1683
POP cycle 50 130 0 0 0 0 0 0 0 0 180 0
DMPA vial 389 350 100 0 144 137 136 417 0 0 422 417
IUD piece 0 0 0 0 0 0 0 0 0 0 0
Implant piece 0 0 0 6 0 0 0 0 0 0 6
Condom piece 940 676 100 0 439 427 382 1248 0 0 468 1248 128
0 0 0
0 0 0
0 0 0
0 0 0
APPROVED BY: DATE:
L M

uarter Order
TOTAL
CR+NR J-I
1683 -190
0 -180
417 -5
0 0
0 -6
1376 908
0 0
0 0
0 0
0 0
DATE ACCOMPLISHED

A B C D F G H I J


Office
B+C+D-F- =F
G-H
COC cycle 300 0 0 0 81 80 83 244 0 0 56 244 22
POP cycle 0 0 0 0 0 0 0 0 0 0 0 0 0
DMPA vial 10 0 0 0 2 4 2 8 0 0 2 8 19
IUD piece 0 0 0 0 0 0 0 0 0 0 0 0
Implant piece 0 0 0 0 0 0 0 0 0 0 0 0
Condom piece 30 0 0 0 10 10 10 30 0 0 0 30 144
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
APPROVED BY: DATE:
L M

uarter Order
TOTAL
CR+NR J-I
266 210
0 0
27 25
0 0
0 0
174 174
0 0
0 0
0 0
0 0
NTORY AND ORDER FORM for RHUs/CHOs v2.5 (GENERAL INSTRUCTIONS)
1. Indicate complete RHU name and number (i.e., Dasmarias I)

2. Express commodities in required units (i.e., in vials, cycles, etc.)
3. Provide inventory data by commodity type, not by brand (i.e., Microgynon, Femme and all other COCs fall under the COC
4. Provide all inventory data being asked for; indicate 0 if no commodity was received, dispensed, issued, transferred, lost;
5. Provide total quarterly amount unless otherwise asked (for dispense and issuance, please also provide a monthly breakdo
6. Review data before submitting to fplogisticshotline@doh.gov.ph cc allan.millar@gmail.com and your FP coordinator at PH
7. For questions: Allan 0917-8591444 or 0929-2748340 (or via email allan.millar@gmail.com)
INFORMATION
B. Stock Available/ Beginning Balance
C. Quantity received
D. Transfers received
E. Quantity dispensed
F. Losses
G. Transfers issued
H. Current stock or ending balance
I. Commodity requirements (TR) for the next qu
J. Request/Order
K. Remarks
v2.5 (GENERAL INSTRUCTIONS)
me and number (i.e., Dasmarias I)

quired units (i.e., in vials, cycles, etc.)
ommodity type, not by brand (i.e., Microgynon, Femme and all other COCs fall under the COC category)
eing asked for; indicate 0 if no commodity was received, dispensed, issued, transferred, lost; if no data or remarks, indicate none
ount unless otherwise asked (for dispense and issuance, please also provide a monthly breakdown)
tting to fplogisticshotline@doh.gov.ph cc allan.millar@gmail.com and your FP coordinator at PHO
8591444 or 0929-2748340 (or via email allan.millar@gmail.com)
DEFINITION
Total quantity of commodities available at the beginning of the quarter in the RHU/CHO and BHSs
Total quantity of commodities received from DOH Central Office (shipped via forwarder e.g. Ximex or AIR21) and from other sources (PHO
Total quantity of commodities issued received from other SDPs (i.e., Cavite City receiving stocks from Noveleta RHU)
Quantity of commodities dispensed to clients at the RHU/CHO including those at the BHS to be tallied monthly and quarterly
Total quantity of commodities removed from the inventory due to reasons other than consumption e.g. expiration, damages, theft, or tho
Total quantity of commodities issued to other SDPs (i.e., Noveleta transferring its excess commodities to Cavite City)
Total quantity of usable commodities available at the end of the quarter i.e. obtained by using the formula: beginning balance plus quantit
less losses less transfers to another RHU/CHO i.e. I = B+C+D-E-F-G
Total commodity requirements for the next quarter where: CR = current commodity requirements which should be equal to the total dispe
commodity requirements for the next quarter including for poor clients who were forced to buy commodities due to stockout and expecte
Total requirements less ending balance i.e. I-H

Indicate any remarks for the commodity e.g. no trained provider, stocks lost due to pilferage, and expiration

Family Planning

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NAME OF RHU/CHO DULONG BAYAN

DATES COVERED JANUARY-MARCH 2016

QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

Stock Available/ Transfers Transfers Current

Central Others Month 1 Month 2 Month 3 Total CR NR

uirements for Request/ Remarks

QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

Stock Available/ Transfers Transfers Current

Central Others Month 1 Month 2 Month 3 Total CR NR

uirements for Request/ Remarks

QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

Stock Available/ Transfers Transfers Current

Central Others Month 1 Month 2 Month 3 Total CR NR

uirements for Request/ Remarks

QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

Stock Available/ Transfers Transfers Current

Central Others Month 1 Month 2 Month 3 Total CR NR

uirements for Request/ Remarks

QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

Stock Available/ Transfers Transfers Current

Central Others Month 1 Month 2 Month 3 Total CR NR

uirements for Request/ Remarks

QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

Stock Available/ Transfers Transfers Current

Central Others Month 1 Month 2 Month 3 Total CR NR

uirements for Request/ Remarks

QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

Stock Available/ Transfers Transfers Current

Central Others Month 1 Month 2 Month 3 Total CR NR

uirements for Request/ Remarks

QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

Stock Available/ Transfers Transfers Current

Central Others Month 1 Month 2 Month 3 Total CR NR

uirements for Request/ Remarks

QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

Stock Available/ Transfers Transfers Current

Central Others Month 1 Month 2 Month 3 Total CR NR

uirements for Request/ Remarks

QUARTERLY FP INVENTORY AND ORDER FORM v2.5(FOR RHU/CHO)

Stock Available/ Transfers Transfers Current

Central Others Month 1 Month 2 Month 3 Total CR NR

uirements for Request/ Remarks

1. Indicate complete RHU name and number (i.e., Dasmarias I)

H. Current stock or ending balance

I. Commodity requirements (TR) for the next qu

me and number (i.e., Dasmarias I)

Total requirements less ending balance i.e. I-H

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