LEVEL 4 EASY COC EXAM LMIS Formats

Bin card -1

Name of the health facility – Black lion hospital pharmacy

Product name, strength, dosage form – cephalexin 250mg/5ml suspension

Unit of issue – bottle

Maximum stock level – 4 month

Minimum stock level –

Emergency order pt – 0.5 month

Average monthly consumption (AMC) –

Date Doc. No. Received Quantity Batch Expiry Remarks

(Receiving From/ Received Issued Loss/Adj Balance No. Date
or issuing) Issued to
1/1/2019 BBF 10,000 2108 9/2020
8/1/2019 M – 22 DISP 3000 7000 2108 9/2020
13/1/2019 M – 22 DISP 4000 3000 2108 9/2020
28/1/2019 M – 19 PFSA 10,000 13,000 2109 12/202
0
2/2/2019 M – 22 YZ -250 12,750 2108 9/2020 Transfer
out
8/2/2019 M – 22 DISP 500 12,250 2108 9/2020 FEFO
13/2/2019 M – 22 DISP 1250 11,000 2108 9/2020
18/2/2019 M – 22 DISP 1000 10,000 2108 9/2020
20/2/2019 M – 19 YZ +1000 11,000 2109 12/202 Transfer
0 in
22/2/2019 M – 22 DISP 4000 7000 2109 12/202
0
23/2/2019 M – 22 DISP 3000 4000 2109 12/202
0
30/2/2019 Physical 0 4000 2109 12/202
inventory 0
Bin card -2

Name of the health facility – Black lion hospital pharmacy

Product name, strength, dosage form – Normal saline 1000ml solution

Unit of issue – bag

Maximum stock level – 4 month

Minimum stock level –

Emergency order pt – 0.5 month

Average monthly consumption (AMC) –

Date Doc. No. Received Quantity Batch Expiry Remarks

(Receivi From/ Received Issued Loss/ Balance No. Date
ng Issued to Adj
or
issuing)
1/1/2019 BBF 2000 125 5/2020
8/1/2019 M – 22 DISP 1000 1000 125 5/2020
10/1/2019 M – 19 DISP 1000 0 125 5/2020
20/1/2019 M – 22 PFSA 3800 3800 3356 1/2020
23/1/2019 M – 22 DISP 800 3000 3356 1/2020 FEFO
18/1/1019 M -22 XXHC -900 2100 33561 1/2020 TRANSF
ER OUT
20/1/2019 M -22 DISP 1000 1100 3356 1/2020 FEFO
20/1/2019 M -22 DISP 100 1000 3356 1/2020
30/1/2019 M -22 DISP 850 150 3356 1/2020
2/2/2019 M – 19 PFSA 4000 4150 0342 6/2023
2/3/2019 M- 22 DISP 150 4000 3356 1/2020 FEFO
22/2/2019 M- 22 DISP 1000 3000 0342 6/2023
23/2/2019 M -22 DISP 2000 1000 0342 6/2023
30/2/2019 PHY 0 1000 0342 6/2023
Bincard -3

Name of the health facility – Black lion hospital pharmacy

Product name, strength, dosage form – paracetamol 100mg/5ml suspension

Unit of issue – bottle

Maximum stock level – 4 month

Minimum stock level –

Emergency order pt – 0.5 month

Average monthly consumption (AMC) –

Date Doc. No. Received Quantity Batch Expiry Remarks
(Receiving From/Issued Received Issued Loss/Adj Balance No. Date
or issuing) to
1/1/2019 BBF 1500 0425 2/2021
8/1/2019 M – 22 DISP 500 1000 0425 2/2021
13/1/2019 M – 22 DISP 200 800 0425 2/2021
18/1/2019 M -19 PFSA 7000 7800 0112 1/2020
23/1/2019 M- 22 LIDETHC -800 7000 0112 1/2020 FEFO
28/1/2019 M -22 DISP 2200 4800 0112 1/2020 FEFO
2/2/2019 M – 22 DISP 1000 3800 0112 1/2020 FEFO
8/2/2019 M -22 DISP 1000 2800 0112 1/2020
13/2/2019 M -22 DISP 500 2300 0112 1/2020
18/2/2019 M – 22 DISP 1000 1300 0112 1/2020
23/2/2019 M -22 DISP 500 800 0112 1/2020
30/2/2019 PHY 0 800 0425 2/2021
Bincard -4

Name of the health facility – Black lion hospital pharmacy

Product name, strength, dosage form – Adrenaline 1mg/ml solution

Unit of issue – ampoule

Maximum stock level – 4 month

Minimum stock level –

Emergency order pt – 0.5 month

Average monthly consumption (AMC) –

Date Doc. No. Received Quantity Batch Expiry Remarks

(Receiving From/Issued Received Issued Loss/Adj Balance No. Date
or issuing) to
1/1/2019 BBF 500 0635 1/2023
8/1/2019 M – 22 DISP 100 400 0635 1/2023
13/1/2019 M – 22 DISP 50 350 0635 1/2023
18/1/2019 M – 22 DISP 50 300 0635 1/2023
23/1/2019 M – 22 DISP 100 200 0635 1/2023
28/2019 M – 22 DISP 20 180 0635 1/2023
3/2/2019 M – 22 DISP 50 130 0635 1/2023
8/2/2019 M – 22 DISP 50 80 0635 1/2023
13/2/2019 M – 19 PFSA 300 380 0435 11/2022
18/2/2019 M – 22 DISP 100 280 0435 11/2022
23/2/2019 M – 22 DISP 200 80 0435 11/2022
30/2/2019 PHY -30 50 0635 1/2023
Bincard -5

Name of the health facility – Black lion hospital pharmacy

Product name, strength, dosage form – Azithromycin 1OOmg/5ml Susp

Unit of issue – ampoule

Maximum stock level – 4 month

Minimum stock level –

Emergency order pt – 0.5 month

Average monthly consumption (AMC) –

Date Doc. No. Received Quantity Batch Expiry Remarks

(Receiving From/Issued Received Issued Loss/Adj Balance No. Date
or issuing) to
1/1/2019 BBF 10000 0738 3/2022
8/1/2019 M – 22 DISP 1000 9000 0738 3/2022

13/1/2019 M – 22 DISP 3000 6000 0738 3/2022

18/1/2019 M – 19 PFSA 4000 10000 0235 1/2020

23/1/2019 M – 22 TULUHC -300 9700 0235 1/2020 FEFO
28/2019 M – 22 DISP 700 9000 0235 1/2020 FEFO
3/2/2019 M – 22 DISP 1000 8000 0235 1/2020 FEFO
8/2/2019 M – 22 DISP 2000 6000 0235 1/2020 FEFO
13/2/2019 M – 22 DISP 500 5500 0738 3/2022
18/2/2019 M – 22 DISP 1500 4000 0738 3/2022
23/2/2019 M – 22 DISP 500 3500 0738 3/2022
30/2/2019 M – 22 DISP -300 3200 0738 3/2022

REPORT & REQUSITION FORM (RRF)

 HEALTH FACILITY – BLACK LION HOSPITAL PHARMACY

REPORTED PERIOD FROM______TO______

SI PRDUCT NAMR Unit of Beginn Quantity Losses Ending Calculated Day Maximum Quantity

N issue / balanc consumptio out of stock quantity

ing Received e n stock
Needed to

O balance Adjust
Reach max
ed

A B C D E=A+B+/- F G=120*E/ I=H-D-E

(60-F)
C-D

1 Cephalexin250mg/ Bottle
5mlsuspention

2 Normal Saline 1000ml Bag

solution

3 Paracetamol100mg/ Bottle
5ml suspention

4 Adrenalin 1mg/ml Ampul

solution e

5 Azitromycin Bottle
100mg/5ml

Quantity Unit Total price Quantity Unit Total

needed price ordered price price
to reach
max

A B C(A×B) D E F=(D×E)

1 Cephalexin Bottle E
250mg/5ml
suspention

2 Normal saline Bag V

 1000ml solution

3 Paracetamol Bottle N
100mg/5ml
suspention

4 Adrenalin 1mg/ml Ampule V

solution

5 Azitromycin Bott E
100mg/5ml susp

TOTAL PRICE
TOTAl PRICE
COAST ANALYSIS FOR WORKSHEET FOR RRF

DRUG BUDGET = 921,760

HEALTH FACILITY – BLACK LION HOSPITAL PHARMACY

REPORTED PERIOD FROM______TO______

D/CE=