Weekly Antiviral Inventory Report
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ANTIVIRAL COURSES TRACKING FOR TREATMENT CENTERS
Form ESF8 107
All sites offering state or federally supplied antiviral courses are required to provide a weekly report of courses administered and in inventory. Report at this site weekly or by fax to 971-673-0278 Attn Samantha Kurosky.
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1
. Name of Site
Name of Site
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2
. Antiviral ID (This will be assienged by your County/Tribe/State Agency)
Antiviral ID (This will be assienged by your County/Tribe/State Agency)
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3
. Contact Person Name
Contact Person Name
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4
. Contact Person Phone
Contact Person Phone
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5
. Contact Person E-mail
Contact Person E-mail
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6
. Week of Report
Week of Report
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7
. Type of antiviral and number of courses given in past 7 days.
Example:
Tamiflu 75mg (10 courses); Pediatric Suspension (5 courses)
Type of antiviral and number of courses given in past 7 days. Example: Tamiflu 75mg (10 courses); Pediatric Suspension (5 courses)
8
. If antiviral courses have been redistrubted by your site to another agency in the past 7 days, please list the name of the site(s) and how many courses were redistributed to each site.
If antiviral courses have been redistrubted by your site to another agency in the past 7 days, please list the name of the site(s) and how many courses were redistributed to each site.
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9
. Total number of antiviral courses remaining in inventory. Please specify type of antiviral.
Example:
Tamiflu 75mg (100 courses); Peditaric Suspension (200 courses)
Total number of antiviral courses remaining in inventory. Please specify type of antiviral. Example: Tamiflu 75mg (100 courses); Peditaric Suspension (200 courses)
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