Republic of the Philippines

Bangsamoro Autonomous Region in Muslim Mindanao

MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

HEALTH FACILITY MONTHLY UTILIZATION/STOCK INVENTORY REPORT FORM

For Public Health Pharmacist Inventory Notes

Name of Facility: BUBUAN BARANGAY HEALTH STATION Date of Province:

Monitoring
Municipality : HADJI PANGLIMA TAHIL SULU

DELIVERIES
STOCK TRANSFER
PREVIOUS
MONTH Expired End of month
InMAP Received Monthly
ENDING quantity date
(C ) Transferre
Consumption stock stocks
d (D)
INVENTORY

Regular Insulin 100 IU/mL, 10 mL

Isophane Insulin Human 100 IU/mL, 10 mL

Biphasic Isophane Human Insulin 70/30, 100

IU/mL, 10 mL

DELIVERIES
STOCK TRANSFER
PREVIOUS
MONTH Expired End of month
MHMAP
Monthly
Received
ENDING Quantity date (C )
Transferr
Consumption stock stocks
ed (D)
INVENTORY

Lithium Carbonate 450mg

Flupentixol Decanoate 20mg/mL, 1mL

Escitalopram 10mg

Fluoxetine 20mg

Fluoxetine 20mg

Quetiapine 200mg

Quetiapine 200mg

Quetiapine 300mg

Sertraline 50mg

Risperidone 1mg

Risperidone 2mg

Risperidone 2mg (Orodispersible)

Risperidone 4mg

Valproate Disodium + Valproic Acid 250mg

Haloperidol 5mg

Haloperidol 5mg/mL, 1 mL

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

Haloperidol 20mg

Olanzapine 10mg

Fluphenazine Decanoate 25mg/mL, 1mL

Fluphenazine Decanoate 25mg/mL, 10mL

Chlorpromazine 200mg

Chlorpromazine 100mg

Carbamazepine 200mg

Biperiden HCl 2mg

Diphenhydramine 50mg/mL, 1mL

Clozapine 25mg

Clozapine 100mg

Divalproex Sodium 250 mg EC Tablet

Divalproex Sodium 500 mg Tablet

Valproate Disodium + Valproic Acid 500mg

Levomepromazine 100mg

Escitalopram 20mg

Oxcarbazepine 600mg

Quetiapine 25mg

Levetiracetam 500mg

DELIVERIES STOCK
TRANSFER
ComPack PREVIOUS Rece
MONTH ived
Monthly
Consumpti
Expired End of month
ENDING (C ) Transfer on stock stocks
Quantity date
INVENTORY red (D)

Metformin 500mg

Amlodipine 10mg

Losartan 50mg

Metoprolol 50mg

Amlodipine 5 mg

Gliclazide 30 mg

Simvastatin 20mg

Simvastatin 40mg

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

DELIVERIES
PREVIOUS STOCK TRANSFER
Family Planning MONTH Received Monthly Expired
End of
ENDING (C ) Consumption stock
month
Transfer
INVENTOR Quantity date
red (D)
stocks
Y

Combined Oral Contraceptives (COC) PILLS

Progestin Only Pills (POP)

Depo Medroxyprogesterone Acetate (DMPA) VIAL

Intra Uterine Device (IUD) TCU 380-A

Male Condoms

Progestin Subdermal Implant (PSI)

DELIVERIES STOCK
TRANSFER
Micronutrient Program PREVIOUS
End of
Rece
MONTH Monthly Expired
ived month
ENDING (C )
Tran Consumption stock
Qua sferr stocks
INVENTORY ntity
date
ed
(D)

Vitamin A 100,000IU

Vitamin A 200,000IU

Ferrous with Folic Acid

Calcium Carbonate

Ferrous Salt Solution, 15ml

Micronutrient Powder

PREVI
DELIVERIES
OUS STOCK TRANSFER
National TB Control Program MONT
H Receive Monthly Expired End of month
ENDIN d Consumption stock stocks
(C ) Transferr
G Quantity date
ed (D)
INVEN
TORY

CAT 1 Anti TB drugs for Adult

Anti TB Drugs for Children (Fixed-Dose

Combination)

Isoniazid Preventive Therapy (IPT) for Children

Anti TB Drugs for Children (Single Dose

Formulation)

Anti TB Drugs for Children (Single Dose

Formulation KIT)

Isoniazid Syrup 200mg/5mL

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

Tuberculin PPD

DELIVERIES
STOCK TRANSFER
MAP (others) PREVIOUS Receive
MONTH d Monthly Expired End of month
ENDING Quanti (C ) Transferre
Consumption stock stocks
date
INVENTORY ty d (D)

Sodium Bicarbonate 1 mEq/mL, 10 mL

Sodium Bicarbonate 1 mEq/mL, 100 mL

Paracetamol 120mg/5mL

Paracetamol 120mg/5mL

Paracetamol 100mg/5mL
Paracetamol 100mg/mL, 15 mL

DELIVERIES
STOCK TRANSFER
PREVIOUS
Receive
MONTH End of month
National Immunization Program (NIP) ENDING
d Monthly
Consumption
Expired
stock stocks
Quantit (C ) Transfer
date
INVENTORY y red (D)

BCG Vaccine

Hepatitis B Vaccine

Pentavalent Vaccine (DPT-Hepatitis B-HiB)

Bivalent Oral Polio Vaccine (bOPV)

Inactivated Polio Vaccine(IPV)

Pneumococcal Conjugate Vaccine (PCV13)

Measles Mumps and Rubella (MMR)

Measles Rubella Vaccine (MR)

Measles Vaccine

Tetanus Diphtheria (TD) Toxoid Vaccine

Human Papillomavirus Vaccine (HPV)

Influenza Vaccine (Flu)

Polysaccharide Polyvalent Vaccine (PPV23)

Rotavirus Vaccine Oral Suspension

PREVIOUS DELIVERIES
Monthly Expired End of month
STOCK TRANSFER Consumption
stock
MONTH stocks
Integrated Helminth Control Program ENDING Quantit date Received Transferr
y ed (D)
INVENTORY (C )

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

Albendazole 400 mg Chewable Tablet

Albendazole 400 mg Tablet

Mebendazole 500mg

Albendazole 200mg Tablet

DELIVERIES
STOCK TRANSFER
PREVIOUS
Health Emergency Management Bureau MONTH Received Monthly Expired End of month
(HEMB) ENDING Quanti
(C )
Transfer
Consumption stock stocks
date
INVENTORY ty red (D)

Amoxicillin Trihydrate 250mg/5mL Powder for

Suspension, 60 mL amber bottle

Amoxicillin Trihydrate 250mg/5mL Powder for

Suspension, 60 mL amber bottle

Amoxicillin Trihydrate 500mg

Ascorbic Acid 100 mg/5 mL Syrup, 120 mL

Bottle

Ascorbic Acid 500 mg Tablet

Aspirin 80 mg

Calamine 8% Lotion 60mL bottle

Lagundi 300mg Tablet

Lagundi 300mg/5ml Syrup

Fusidic Acid

DELIVERIES
STOCK TRANSFER
PREVIOUS
National Leprosy Prevention and Control MONTH Received Monthly Expired End of month
Program ENDING Quantit
date
(C )
Transferr
Consumption stock stocks
INVENTORY y ed (D)

Betamethasone 5g

Cloxacillin Sodium 125mg/5mL, 60mL

Prednisone 10mg

Cloxacillin 500mg

DELIVERIES
STOCK TRANSFER
Rabies Program
PREVIOUS
MONTH Monthly Expired End of month
ENDING Consumption stock stocks
Received
INVENTORY Quanti
date
Transfer
ty (C ) red (D)

Purified Chick Embryo Cell Rabies Vaccine 2.5

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

IU/mL

Anti-Rabies Serum (Equine) 200 IU/mL (1,000

IU/5mL)

Purified Chick Embry Cell (PCEC) Rabies Vaccine

2.5IU/mL Lyophilized Powder for Injection

STOCK
DELIVERIES Monthly Expired End of month
TRANSFE
Philippine Integrated Management of
Consumption stock stocks
PREVIOUS R
MONTH
Severe Acute Malnutrition (PIMAM) ENDING
INVENTOR Received
Transferred
Quantity date (C )
Y (D)

Ready-to-Use Supplementary Food (RUSF)

Ready-to-Use Therapeutic Food (RUTF)

End of month
DELIVERIES
Monthly Expired stocks
Consumption stock
STOCK TRANSFER
PREVIOUS
Integrated Management of Childhood MONTH
Illness (IMCI) ENDING
INVENTORY

Quantity date
Received Transferre
(C ) d (D)

Amoxicillin 100 mg/mL, granules powder for

drops, 15 mL

Amoxicillin Trihydrate 250mg/5mL Powder for

Suspension, 60 mL amber bottle

Zinc Drops

Zinc Syrup

Amoxicillin 100mg/ml 10ml Drops

Ferrous sulfate 75mg/0.6ml, 15ml

Ferrous sulfate 150mg/5ml

DELIVERIES
STOCK TRANSFER
PREVIOUS
Oral Health MONTH Received Monthly Expired End of month
ENDING (C ) Consumption stock stocks
Quan Transferr
date
INVENTORY tity ed (D)

Flouride Varnish

Glass Ionomer

Composite Restorative Material

Pits and Fissure Sealants

Essential Health Care Package 1

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

Essential Health Care Package 2

DELIVERIES
PREVIOUS STOCK TRANSFER
Food and Waterborne Disease Program MONTH Receiv
Monthly Expired End of month
(FAWDP) ENDING Consumption stock stocks
Quantit ed Transferre
date
INVENTORY y (C ) d (D)

Metronidazole 125mg/5 ml, 60 ml bottle

Metronidazole 250mg suspension

Metronidazole 250mg Tablet

Metronidazole 500mg Tablet

Oral Rehydration Salts (ORS)

PREVIOUS DELIVERIES STOCK TRANSFER Monthly

Consumption
Expired End of month
MONTH stock stocks
Schistosomiasis Control Program ENDING
INVENTORY
Quanti Transferre
ty
date Receive d (D)
d
(C )

Praziquantel 600mg

PREVIOUS DELIVERIES STOCK TRANSFER Monthly

Consumption
Expired End of month
MONTH stock stocks
DOH-CHD PROCURED ENDING
INVENTORY
Transferr
Quantity date
Received ed (D)
(C )

Azithromycin 500mg

LGU PROCURED PREVIOUS DELIVERIES STOCK TRANSFER Monthly Expired End of month
Consumption
MONTH stock stocks
ENDING Quantity date Received Transferr
ed (D)
INVENTORY (C )

Simvastatin 20mg

PREVIOUS DELIVERIES STOCK TRANSFER Monthly

Consumption
Expired End of month
MONTH stock stocks
Senior Citizen Program ENDING
INVENTORY Transferr
Quantity date
Received ed (D)
(C )

Cloxacillin 500mg

Tamsulosin 200mcg

Colchicine 500mcg

Hyoscine-N-Butylbromide 10mg

Omeprazole 20mg

Salbutamol 2mg

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

Vitamin B1 B6 B12 100 mg + 5 mg + 50 mcg

Tablet

Gliclazide 80mg

Cefuroxime (as axetil) 500 mg tablet

Tranexamic 500mg

Betahistine 16mg

Ceftriaxone 1g (as disodium/sodium salt)

DELIVERIES
STOCK TRANSFER
F1+ BOTIKA NG BAYANI (BNBi) PREVIOUS
MONTH Monthly Expired End of month
ENDING Received Consumption stock stocks
Transfer
Quantity date (C )
INVENTORY red (D)

Cefuroxime (as axetil) 500 mg tablet

Ciprofloxacin (as hydrochloride) 500 mg tablet

Clindamycin (as hydrochloride) 300 mg

Cotrimoxazole 800 mg sulfamethoxazole + 160

mg trimethoprim tablet

Co-Amoxiclav 625 mg tablet

Fusidate Sodium/Fusidic Acid cream2%, 5 g

Mupirocin 2%, 5 g ointment

Metronidazole 500mg Tablet

Celecoxib 200 mg capsule

Omeprazole 20mg

Clopidogrel 75 mg tablet

Salbutamol (as sulfate) 1 mg/mL, 2.5 mL (unit

dose)nebule

Salbutamol 100 mcg/dose x 200 doses Metered

Dose inhaler

Salbutamol 2 mg/5 mL, 60 mL syrup bottle

Anti-Tetanus Serum (Equine) 1,500 IU/mL,

2.5mL

Vitamin B1 B6 B12 100 mg + 5 mg + 50 mcg

Tablet

PREVIOUS DELIVERIES
Monthly Expired End of month
STOCK TRANSFER Consumption
stock
MONTH stocks
F1+ BOTIKA NG BAYAN (BNB) ENDING Quantity date Received Transfer
red (D)
INVENTOR (C )
Y

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

Cefalexin 500mg

Cefuroxime (as axetil) 500 mg tablet

Ciprofloxacin (as hydrochloride) 500 mg tablet

Cloxacillin (as sodium)500 mg tablet

Cotrimoxazole 400 mg sulfamethoxazole + 80
mg/ 15 mL syrup, 60 mL

Cotrimoxazole 800 mg sulfamethoxazole + 160

mg trimethoprim tablet

Co-Amoxiclav 625 mg tablet

Fluticasone + Salmeterol 125 mcg + 25 mcg x

120 doses Metered Dose inhaler

Fluticasone + Salmeterol 250 mcg + 25 mcg x

120 doses Metered Dose inhaler

Salbutamol (as sulfate) 1 mg/mL, 2.5 mL (unit

dose)nebule

Salbutamol 100 mcg/dose x 200 doses Metered

Dose inhaler

Fusidate Sodium/Fusidic Acid cream2%, 5 g

Mupirocin 2%, 5 g ointment

Omeprazole 40 mg capsule

Clopidogrel 75 mg tablet

Celecoxib 200 mg capsule

Aspirin 80 mg

Amoxicillin Trihydrate 500mg

Amoxicillin 100 mg/mL, granules powder for

drops, 15 mL

Amoxicillin Trihydrate 250mg/5mL Powder for

Suspension, 60 mL amber bottle

Atorvastatin 40 mg tablet

Vitamin B1 B6 B12 100 mg + 5 mg + 50 mcg

Tablet

Multivitamins per 5 mL, 120 mL Syrup bottle

Mefenamic Acid 50mg/mL, 60mL

Mefenamic Acid 500mg

Celecoxib 400mg

Salbutamol 2 mg/5 mL, 60 mL syrup bottle

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

Cefalexin 250 mg syrup

Multivitamins per 5mL, 60 mL Syrup bottle

Monitored/Inventoried by:
Approved By:

__________________________

List of Medicines
under Monitoring of
Pharmaceutical
Division Regional Unit
Zenaida P. Bale,RPh,MPA – FDRO III/NDPCO

Rosalie O. Samorin,RPh- Public Health Pharmacist-Maguindanao

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
MINISTRY OF HEALTH
Bangsamoro Government Center, RH 7, Gov. Gutierrez Avenue, Cotabato City

Aslima A. Mamaki,RPh-Public Health Pharmacist-Lanao

Nurlaine U.Ahamad,RPh- Public Health Pharmacist-sulu

Catherine Ann A. Cuevas,RPh- Public Health Pharmacist-Basilan

Nushyba B. Aradais,RPh- Public Health Pharmacist-tawi-tawi

____________________________________________________________________________________________________________________
_
E-mail: moh@bangsamoro.gov.ph “ Asahan MOH sa
Kalusugan “
Tel. No: (064) 552-0086