REQUISITION AND ISSUE SLIP

ame : Bureau of Jail Management and Penology, R8 Fund Cluster : ___________________

Division : Health Service Responsibility Center Code : ______________

Office : Tacloban City Jail Male Dormitory RIS No. : _____________________________

Requisition Stock Available? Issue
Stock No. Unit Description Quantity Yes No Quantity Remarks
0326 Bxs Aciclovir 400 mg Tablet 30's's 20 / 20 Issued
0166 Bxs Amlodipine 10 mg Tablet 100's 150 / 150 Issued
0167 Bxs Amoxicillin 500 mg Capsule 100's 60 / 60 Issued
0231 Bxs Sodium Ascorbate 500 mg Tablet 100's 250 / 250 Issued
0363 Bxs Betamethasone Cream 0.1%, 5 g Tube 30 / 30 Issued
0170 Bxs Bisacodyl 5 mg Tablet 100's 20 / 20 Issued
0171 Bxs Captopril 50 mg Tablet 20 / 20 Issued
0173 Bxs Cefalexin 500 mg Capsule 100's 60 / 60 Issued
0174 Bxs Cefuroxime 500 mg Tablet 10's 20 / 20 Issued
0175 Bxs Cetirizine 10 mg Tablet 100's 60 / 60 Issued
0177 Bxs Ciprofloxacin 500 mg Tablet 100's 30 / 30 Issued
0180 Bxs Cloxacillin (as Sodium) 500 mg Capsule 100's 20 / 20 Issued
0181 Bxs Co-Amoxiclav (Amoxicillin + Potassium Clavulanate) 500 mg +125 20 / 20 Issued
mg Tablet 14's
0182 Bxs Cotrimoxazole (Sulfamethoxazole + Trimethoprim) 800 mg + 160 20 / 20 Issued
mg Tablet 100's
0187 Bxs Diphenhydramine (as Hydrochloride) 50 mg Capsule 100's 20 / 20 Issued
0193 Bxs Ferrous Sulfate 60 mg elemental iron Tablet 20 / 20 Issued
0365 Bxs Hydrocortisone Cream 1%, 5 g Tube 20 / 20 Issued
0197 Bxs Hyoscine (as N-butyl bromide) 10 mg Tablet 100's 100 / 100 Issued
0198 Bxs Ibuprofen 400 mg Tablet 100's 100 / 100 Issued
0272 Bxs Ipratropium + Salbutamol 500 mcg + 2.5 mg x 2.5 mL (unit dose) 20 / 20 Issued
Respiratory Solution 30's
0202 Bxs Lagundi 300 mg Tablet 100's 60 / 60 Issued
0301 Bxs Lidocaine 2%, 1.8 mL w/ Epinephrine Capsule 20 / 20 Issued
0303 Bxs Loperamide Hydrochloride 2 mg Capsule 100's 100 / 100 Issued
0205 Bxs Loratadine 10 mg Tablet 100's 30 / 30 Issued
0206 Bxs Losartan 50 mg Tablet 100's 150 / 150 Issued
0208 Bxs Mefenamic Acid 500 mg Capsule 100's 100 / 100 Issued
0209 Bxs Metformin Hydrochloride 500 mg Tablet 100's 20 / 20 Issued
0210 Bxs Metoprolol (as Tartrate) 50 mg Tablet 100's 20 / 20 Issued
0211 Bxs Metronidazole 500 mg Tablet 100's 20 / 20 Issued
0213 Bxs Multivitamins for adults Capsule 100's 150 / 150 Issued
0247 Bxs Mupirocin Ointment 2%, 5 g Tube 30 / 30 Issued
0220 Bxs Omeprazole 20 mg Capsule 100's 30 / 30 Issued
0221 Bxs Oral Rehydration Salts (ORS 75-replacement) 4.1 g Sachet 30's 20 / 20 Issued
0222 Bxs Paracetamol 500 mg Tablet 100's 100 / 100 Issued
0226 Bxs Salbutamol 2 mg/mL, 2.5 mL (unit dose) Nebule 20 / 20 Issued
0318 Bxs Silver Sulfadiazine Cream 1%, 15 g Tube 30 / 30 Issued
0236 Bxs Tobramycin Eye Drops 0.3%, 5 mL Bottle 20 / 20 Issued
0237 Bxs Tranexamic Acid 500 mg Capsule 100's 20 / 20 Issued
0238 Bxs Vitamin B1 B6 B12 100 mg + 5 mg + 50 mcg Tablet 100's 150 / 150 Issued
0179 Bxs Clotrimazole Cream 1% 10gms aluminum Tube 30 / 30 Issued
0264 Bxs Doxycyline (as Hyclate) 100mg capsule 100's 30 / 30 Issued
0234 Bxs Paracetamol Phenylpropanolamine HCL Chlorphenamine Maleate 100 / 100 Issued
325mg/25mg/2mg x100
0172 Bxs Carboceistein 500 mg 100's 100 / 100 Issued
*** Nothing Follows***

Purpose: For Use of Tacloban City Jail Male Dorm for the 1st Semester 2023 S

Requested by: Approved by: Issued by: Received by:

Signature :

Printed Name : J/CINSP G GADONG J/CINSP SAN GABRIEL JO2 IK Fevidal J/CINSP G GADONG

Designation : Jail Warden C, HSD OIC, RSAO Jail Warden

Date : August 23, 2023 August 23, 2023 August 23, 2023 August 23, 2023