AYUSHMAN BHARAT HEALTH AND WELLNESS CENTER
Daily Medicine Use Tracker Month: ......................................
No Item Opening 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total Closing
Quantity Used Quantity
1 Diclofenac- Tablet 50 mg
2 Paracetamol- Tablet 500 mg
Paracetamol- Tablet 250 mg
3 Kid
Paracetamol- Syp
4 Paracetamol- 1250 ml/ 5 ml
Acetylsalicylic Acid Tablet 75 mg/
5
150 mg Dispersible
6 Ibuprofen- Tablet 200 mg
7 Ibuprofen- Oral liquid 100 mg/5 ml
8 Mefenamic acid Capsule 250 mg
9 Cetrizine - Tablet 10 mg
10 Cetrizine - Syrup 5 mg/ 5 ml
11 Albendazole- tablet 400 mg
12 Ciprofloxacin- Tablet 250 mg
13 Geentamicine Injection 10 mg / ml
Amoxicillin Tablet 250 mg
14
(Dispersible)
15 Amoxicillin Capsule 500 mg
16 Amoxicillin oral liquid 125 mg/ 5 ml
17 Fluconazole Tablet 100 mg
18 Primaquine Tablet 7.5 mg
19 Chloroquine tablet 150 mg
Ferrous (A) Folic acid (B)
20 Tab 45 mg elemental iron (A)
+400 mcg (B)
AYUSHMAN BHARAT HEALTH AND WELLNESS CENTER
Daily Medicine Use Tracker Month: ......................................
No Item Opening 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total Closing
Quantity Used Quantity
Ferrous (A) Folic acid (B)
21 Tab 100 mg elemental iron (A)
+500 mcg (B)
Ferrous (A) Folic acid (B)
22 oral liquid 20 mg elemental iron (A)
+500 mcg (B)/ ml
23 Folic acid Tablet 5 mg
24 Ascorbic acid ( Vitamin C) Tablet
100 mg
Multivitamin / Riboflavine Tablet
25
10 mg
26 Multivitamin Drop
27 Vitamin A Oral liquid 10000 IU/ ml
Phytomenadione (Vitamin K1)
28 Injection 10 mg/ ml
29 Povidone iodine Solution 4% to
10%
30 Silver sulphadiazinc Cream 1%
31 Ranitidine Tablet 150 mg
32 Misoprostol Tablet 100 mg
33 Isosorbidedinitrate Tablet 5 mg
34 Isosorbidedinitrate Tablet 10 mg
35 Clopidogrel Tablet 75 mg
36 Frurosemide Tablet 40 mg
37 Glimepiride Tablet 02 mg
38 Metformin Tablet 500 mg
39 Carbamazepine Tablet 200 mg
40 Phenytoin Tablet 100 mg
AYUSHMAN BHARAT HEALTH AND WELLNESS CENTER
Daily Medicine Use Tracker Month: ......................................
No Item Opening 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total Closing
Quantity Used Quantity
41 Sodium valproate- Tablet 200 mg
42 Salbutamol- Tablet 4 mg
Salbutamol- Inhalation
43
(MDI/DPI) 100mcg/dose)
44 Amlodipine- Tablet 5 mg
45 Nifedipine- Tablet 10 mg
46 Atenolof- Tablet 50 mg
ciprofloxacin Eye Drop-
47
Drops 0.3%
Clorimazale Ear Drop-
48 Drops 0.1%
XYLOMETAZOLINE- 0.001
49
Nasal Drop 10Ml
inj. Tetanus Toxoid- 0.5 ml
50
multi dose vial, 5 ml vial
51 inj. Adrenaline- 1 mg/ml, 1 ml
ampoule
inj. Hydrocortisone- 200 mg
52
dry Powder
inj. Dexamethasone- 4
53 mg/ ml, 2 ml Vial
25 % Dextrose- 100 ml,
54
FFS Bottles
Atropine Injection- 0.6
55
mg/ ml
CALCIUM& VITAMIN D3-
56 Tabtet
CALCIUM& VITAMIN D3-
57
Supension
58 CHOLECACIFEROL- Sachet
59
60
AYUSHMAN BHARAT HEALTH AND WELLNESS CENTER
HWC Meeting Register
..............................................................................[ MEETING TITLE]
Date: / / Time: AM / PM
MEETING CALLED BY
TYPE OF MEETING AAA/ HWC/ Monthly Meeting/ VHSNC / JAS/ Other
AGENDA TOPICS
1
2
3
4
Discussion
Conclusions
ACTION ITEMS PERSON RESPONSIBLE DEADLINE
Name of ATTENDES DESIGNATION ( inuke) SIGNATURE( gLrk{kj)
AYUSHMAN BHARAT HEALTH AND WELLNESS CENTER
Visitor Register
Name of Visitor:
Designation:
Date: Time:
Purpose of the visit:
Key Observation:
Key Suggestions:
Action Point with Time line:
Signature
AYUSHMAN BHARAT HEALTH AND WELLNESS CENTER
Wellness Register
Name of wellness activity
Date: Place of celebration: HWC / Outreach /Other......................
Starting Time: End Time:
Objectives of Wellness Activity:
Description of Wellness Activity:
No of Participants participated in the wellness activity:
Total No of Male Participants Total No of Female
NAME OF ATTENDEES DESIGNATION(heoveece) SIGNATURE(nmlee#ej)
AYUSHMAN BHARAT HEALTH AND WELLNESS CENTER
Diagnostic Test Tracker Month: ......................................
No Item Opening 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total Closing
Quantity Used Quantity
1 Haemoglobin
Urine test for pregnancy-
2
Rapid card test(distick)
Urine Strip (dipstick)
3 (multiparameter)
Blood Suger (Glucometer)
4 with Stripes
5 Malaria (Rapid test)
6 HIV (Antibodies to HIV 1&2)
- Rapid card test
7 Dengue- Rapid card test for
NSI antigen and lgM and lgM antibodies
test for iodine in salt (Used
8 for food)- lodine in salt testing kit
Water testing for faecal
9
contamination and chlorination- Strip method
10 HbsAg test for Hepatitis B-
Rapid card test
11 Filariasis ( endemic areas
only)- FST- Rapid
12 Syphilis- Rapid test kit
Sputum for AFB # -
13 Microscopy
Visual Inspection - Acetic
14
Acid
15 Typhoid- Rapid test kit
Signature Signature
Verifier ( Medical Officer of Linked PHC / CHC) Community Health Officer