It is advisable to make a request on a standard stores requisition/delivery (issue) form (see Diagram 3). The stores requisition/delivery (issue) form should be produced in four copies. The original and two other copies of the form will be sent to the central store when completed. The fourth copy is kept in the dispensary to remind the health worker in charge of drugs or items requested.

Ensure that the following items are filled in correctly:

• Name of drug and dosage form;

• Unit of issue and quantity requested;

• The requisition number (it is preferable to begin with a new number each year, e.g. 1/00);

• The name of the dispensary and the date the requisition was made;

• The name and signature of the health worker making the requisition;

• Where the stores requisition/delivery (issue) form is designed to contain all the items listed, fill in only the quantities of those items needed;

• Write down the approximate unit price of each requested item and the approximate total cost of each item;

• Name and signature of the health worker making the requisition;

• The head of the health centre and a representative of the health committee should endorse the stores requisition/delivery (issue) form.

Diagram 3
Model Drug Stores Requisition/Delivery (Issue) Form

For official use only

To be completed in four copies.

• Period for which supply is required, from _______________ to _______________

• The dispenser should comment on excess or short supply in the remarks column.

Name and signature of dispenser at health centre: ____________________________________

Name and signature of member of health committee: __________________________________

Name and signature of head of heath centre: _________________________________________