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Appendix 63
REQUISITION AND ISSUE SLIP
Entity Name : CHED RO1 Fund Cluster : ______________________
Division : ________________________________ Responsibility Center Code : ______
Office : _________________________ RIS No. : RIS2026-00023
Stock No. Unit Description Quantity Stock Available? Issue
Yes No Quantity Remarks
2762 PC Aneroid Sphygmomanometer & Double-Head Stethoscope 1 / 1
2763 PC Glucometer 1 / 1
2764 PC Glucometer strip, 25 STRIPS/BOTTLE 1 / 1
2765 BOTTLE Glucometer Lancets, 200 PCS/BOTTLE 1 / 1
2766 PC Pulse Oximeter 1 / 1
2767 PACK Cotton balls, 150 PCS/PACK 1 / 1
2768 PACK Elastic Bandage Wrap with Clips Flexible Firm Soft Support 3 In x 5 yard Stretch 4 / 4
2769 BOX Medical Plaster Strips Adhesive Antiseptic Band Aid, 100 PCS/BOX 1 / 1
2770 PACK Sterile Gauze pads 4x4 inches, 10 PCS/PACK 10 / 10
2771 ROLL Micropore medical tape, 1 inch 3 / 3
2772 BOTTLE Ethyl Alcohol (70%), 500ml 3 / 3
2773 BOTTLE Betadine Povidone Iodine Solution 10% - 25 ML 5 / 5
2774 BOX Disposable latex gloves, medium size, 100 PCS/BOX 1 / 1
2775 PAIR Surgical Sterile Latex Gloves, 7.5 size 5 / 5
2776 PC Cold compress 1 / 1
2777 PC Syringe with needle, 5ml 5 / 5
2778 PC Oral thermometer (non-mercury/nonglass) 1 / 1
2779 PC Paracetamol 100 / 100
2780 PC Phenylpropanolamine HCl + Paracetamol 25 mg/325 mg 100 / 100
2781 PC Clonidine (75 mcg) 3 / 3
2782 PC Loperamide (2 mg) 20 / 20
2783 PC Ibuprofen Paracetamol (500 g) 100 / 100
2784 PC Antibiotic ointment packets Zinc Oxide + Calamine (3.5 g) 2 / 2
2785 PC Mupirocin 20mg/g Ointment 5g 2 / 2
2786 PC Hydrocortisone ointment Hydrocortisone 10 mg/g Cream 15 g) 2 / 2
2787 PC Hyosine N-butylbromide, 10 mg 20 / 20
2788 BOTTLE Tetrahydrozoline hydrochloride, 7.5 ml 2 / 2
Purpose: FOR PERSONNEL USE (ES INCHARGE FOR THE MEDICINES AND EQUIPMENT)
Requested by: Approved by: Issued by: Received by:
Signature:
Printed Name: MARIA CARMELA DOMOCMAT NYMPHA N. BUENIO RICKY A. CERA
Designation: EDUCATION SUPERVISOR II Chief, Administrative Officer Supervising Administrative Officer/ Supply Officer
Date: 2026-01-19