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MN Asset Cache Inventory Tracking


Please fill this out by 10 am every Tuesday. This online tool replaces the form that you have been sending or faxing to MDH each week. Note: Use tab or your mouse to go from one field to the next. Don't hit enter until you are ready to submit the survey.
Facility information:
Reporting Facility Name
Person Reporting
County
Reporting Date //
Public Health Region

Please enter your current inventory of antivirals (just numbers, no words) from the Minnesota cache. Include the number of full regimens, not individual pills.
Pharmaceuticals Regimens
Oseltamivir (Tamiflu) 75mg
Oseltamivir (Tamiflu) 60mg
Oseltamivir (Tamiflu) 45mg
Oseltamivir (Tamiflu) 30mg
Oseltamivir (Tamiflu) Oral Supension
Zanamivir (Relenza) 5mg

If Other Pharmaceutical not on list above, please specify:
Name
Regimen

Comments:



Vovici survey software