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    Delivery Discrepancy Report Form

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    jimelyquinones78

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    © All Rights Reserved
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    Delivery Discrepancy Report Form

    Uploaded by

    jimelyquinones78
    117 views1 page

    Original Title

    DELIVERY DISCREPANCY REPORT FORM

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    117 views1 page

    Delivery Discrepancy Report Form

    Uploaded by

    jimelyquinones78

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    Republic of the Philippines

    Department of Health
    OFFICE OF THE SECRETARY

    DELIVERY DISCREPANCY REPORT FORM


    Name of Receiving Health Facility: Name of Accountable person/Alternate:

    Address: Contact number:

    A. DETAILS OF DELIVERY
    A.1 Date and Time of Delivery: A.2 Invoice Receipt of Property (IRP) Number:

    A.3 Date of IRP: A.4 Waybill Number:

    A.5 Name of Service Provider: A.6 Name of Courier Staff:

    A.7 Number of cartons received: A.8 Number of cartons NOT received:

    B. DETAILS OF DISCREPANCIES
    B.1. Medicines missing based on the IRP (Mga gamot na kulang o nawawala base sa IRP) :
    Item Description Unit of Total Quantity to Actual Quantity
    Measure be received Delivered

    B.2. Medicines issued in error (Mga gamot na natanggap na sobra o wala sa IRP) :
    Item Description Unit of Total Quantity to Actual Quantity
    Measure be received Delivered

    B.3. Breakages/Damages (Mga gamot na may sira, basag o depekto):


    Item Description Unit Quantity

    B.4. Any other discrepancies/comments (Mga karagdagang puna o komento):

    Deliveries Received by: Witnessed by: Attested by:


    (Health Facility Staff) (Health Facility Staff) (Courier Staff)

    Signature
    Printed Name
    Designation

    *Please accomplish the form in three (3) copies. Provide one copy each for the courier, health facility and DOH Pharmacist.
    Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ● Trunk Line 651-7800 Direct Line: 711-9501
    Fax: 743-1829; 743-1786 ● URL: http://www.doh.gov.ph; e-mail: osec@doh.gov.ph

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