Republic of the Philippines

Department of Health
OFFICB OF THE SECRETARY

June 13,2016

DEPARTMENT MEMORANDUM
No.20l6 - ozor

TO ALL REGIONAL DIRECTORS, PHARMACISTS,

CITY/}IUNICIPAL HEALTH OFFICERS

SUBJECT IMPLEMENTATION ON THE USE OF THE DELIVERY

DISCREPANCY AND EXPIRED MEDICINES FORM FOR ALL
DOH PUBLIC HEALTH PROGRAMS

The Office for Health Regulation (OHR) through the Pharmaceutical Division (pD) has been
providing free medicines to the different health facilities nationwide. With the
implementation of the different Medicines Access Programs (MAPs) there were several
complaints received on the inconsistencies in the delivery of the different DOH commodities
that are delivered to the health facilities.

In order to properly document all discrepancies in the deliveries of all DOH Commodities, all
health facilities are required to use the attached Delivery Discrepancy Report Form (Annex
A). This form must be accomplished on the time of delivery and must be acknowledged by
the service provider staff. The form must be accomplished in 3 copies. A copy must be given
to the service provider staff, DOH Pharmacist and one copy to be retained in the health
facility' Likewise, an Expired Medicines Report Form (Annex B) shall also be
accomplished to document all expired DOH commodities. Please ensure that both forms are
duly accomplished and signed by the approving authority.

Funding for the reproduction and dissemination of the forms shall be charged against the
funds sub-allotted by the Pharmaceutical Division to all Regional Offices subj-ect to the usual
accounting rules and regulations.

For strict compliance.

By Authority of the Secretary of Health:

tr. HARTIGAN - GO. MD

ry of Health
Office for Health Resulations

Building l, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila o Trunk Line 651-7800 Direct
Line: 711-9501
F ur: 7 43 -1 829 ; 7 43 - 17 86 o URL: http ://rwr.rv. t1oh. gov.ph
; e-mail : csec@doh. gov. nh
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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 Deliverv: A.2 Invoice Receipt of Property (lRP) Number:

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

A.5 Name of Service Provider: 4.6 Name of Courier Staff:

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

B. DETAILS OF DISCREPANCIES :'::,::

B.1. Medicines missing based on the IRP (Msa samot na kulans o nawawala base sa IRPI :

Item Description Unit of Total Quantity to Actual Quantity

Measure be received Delivered

8.2. Medicines issued in error (Mga samot na natanssap na sobra o wala sa IRPI :

Item Description Unit of Total Quantity to ActualQuantity

Measure be received Delivered

8.3. Breakages/Damages (Mga gamot na may sira, basag o depektolt

Item Description Unit Quantity

B.4. Any other discreDancies/comments (Mga karagdasans puna o komentol:

Deliveries Received by: Witnessed by: Attested by:

(Hedte raciti4l stolJ) (Health FacitiE staJl) tCourierStalfl

Signature
Printed Name
Designation
*Please accomplish the
Jbrm in three (3) copies. Provide one copy each Jbr the courier, Iteulth Jitcilit! and DOH Phurmucist.

Building l, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila o Trunk Line 651-7800 Dilect Line: 7l I -9501
Fax: 743-l 829; 743-1786 r URL: httn://www.doh.gov.oh e-rnail: osec@doh.eov.oh
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