Pharmacy — HOS · Sri Venkateshwara Multi-Speciality Hospital

Prescription safety net

Second screening at the counter — interaction, duplicate molecule, allergy and label-ceiling checks against a licensed drug database

4 open flags 3 of the 4 prescriptions waiting

Label ceiling vs a recorded eGFR of 44 — Lakshmi Devi, T-12

Today's line is Tab. Metformin 1000mg, 1-0-1, 30 days. The most recent renal function in her record is eGFR 44 mL/min/1.73m² (KFT, Yashoda Hospital, 14 Mar 2026, seen under her ABHA consent). The licensed label caps the metformin daily dose below eGFR 45. HOS is not proposing a dose and has not altered the prescription — it needs Dr. K. Ramesh to confirm or amend the line, or the line stays held.

Sources: Rx 18 Jul 10:04 AM · KFT 14 Mar 2026 (ABHA) · licensed drug database Reference alert · your call

Penicillin allergy on file vs Amoxicillin-Clav 625mg — Lakshmi Devi, T-12

Her allergy list records Penicillin (2022) and Sulfonamides (2022). Amoxicillin is a penicillin. Dr. K. Ramesh recorded an override against this prescription at 09:47 AM — note: "Apollo Clinic Rx 02 Jan 2026, Amoxicillin 500mg, patient reports no reaction." The substitute chosen at the counter is the same molecule, so that override still covers it. It does not create a new one, and HOS did not clear the allergy.

Sources: AllergyIntolerance 2022 ×2 · prescriber override 18 Jul 09:47 AM · external Rx 02 Jan 2026 (ABHA) Reference alert · your call

Documented interaction — Telmisartan + Diclofenac — Venkatesh Naidu, T-15

His two lines today are Tab. Telmisartan 40mg OD and Tab. Diclofenac 50mg BD. The licensed database records a moderate interaction between angiotensin-receptor blockers and NSAIDs. The values already in his record: BP 146/94 (OPD, today 09:41 AM) and creatinine 1.1 mg/dL, dated 22 Apr 2026 — the KFT Dr. Ramesh ordered this morning (Lab T-25) has not been collected yet, so this flag is running on a 3-month-old renal value and says so. HOS states the interaction and the values; it does not rank them, and it does not suggest a change.

Sources: Rx 18 Jul 09:44 AM · vitals 18 Jul 09:41 AM · KFT 22 Apr 2026 · licensed drug database Reference alert · your call Low confidence — stale renal value

Same molecule in two products — paracetamol — Mohd. Irfan, T-17

Two of his three lines contain paracetamol: Tab. Paracetamol 650mg, 1-1-1 and Tab. Nimesulide 100mg + Paracetamol 325mg, 1-0-1. Combined paracetamol at the doses written is 2,600 mg/day (1,950 + 650). The licensed adult ceiling is 4,000 mg/day. Recorded so the dispensing label prints the combined total rather than each product's own — which is the number that matters if he adds anything over the counter.

Sources: Rx 18 Jul 10:09 AM ×2 lines · licensed drug database (composition + adult ceiling) Duplicate molecule · below ceiling

Two layers, not one. Dr. Ramesh's screen ran the same three checks when he prescribed; this is the independent second pass a pharmacist exists to make, and it is the layer that catches the outside KFT the consulting room did not have on screen. HOS never changes a prescription, proposes a dose or names a diagnosis — it states what is in the record and what the licensed label says, and every flag needs a person to close it. Administration → AI Quality classes this feature as Reference tier: alerts only.

Waiting to dispense

4

T-12

Lakshmi Devi

Dr. K. Ramesh · 4 items · 2 flags

T-15

Venkatesh Naidu

Dr. K. Ramesh · 2 items · 1 flag

T-17

Mohd. Irfan

Dr. P. Anil Kumar · 3 items · 1 flag

T-19

Padma Sree

Dr. Sunitha Rao · 1 item · clear

Avg wait 6 min · WhatsApp "ready" ping sends automatically on dispense · 4 flags across 3 of these 4 prescriptions

Lakshmi Devi ·58F · T2DM ·Token T-12 ·Dr. K. Ramesh ·ABHA 91-4327-8810-4455 Rx dated 18 Jul 2026

Swipe the table sideways for batch, unit price and amount — the payable total is restated below.

Drug	Dosage instructions	Qty	Batch	Unit	GST	Amount
Tab. Metformin 1000mg Batch MET-2503B · exp 31 Jan 2027 · FEFO ✓ oldest usable batch	రోజుకు రెండు సార్లు — భోజనం తర్వాత 1-0-1, 30 days	60	MET-2503B	₹2.10	12%	₹126.00
Tab. Telmisartan 40mg Batch TEL-2403C · exp 12 Aug 2026 · FEFO ✓ only batch, 25 days left	ఉదయం ఒకసారి — ఖాళీ కడుపుతో 1-0-0, 30 days	30	TEL-2403C	₹4.50	12%	₹135.00
Tab. Pantoprazole 40mg Batch PAN-2401E · exp 09 Sep 2026 · FEFO ✓ oldest usable batch	అల్పాహారం ముందు ఒకసారి 1-0-0, 30 days	30	PAN-2401E	₹3.80	12%	₹114.00
Tab. Amoxicillin-Clav 625mg (Augmentin) Preferred brand out of stock — substituted below	రోజుకు రెండు సార్లు — భోజనం తర్వాత 1-0-1, 5 days	10	AMC-2405B	₹14.00	12%	₹140.00

✦ Substitute suggested — same composition Draft — awaiting approval

Augmentin 625 Duo is out of stock (0 units). Suggesting Moxikind-CV 625 — Amoxicillin 500mg + Clavulanic Acid 125mg, identical composition, HSN 30041000, batch AMC-2405B (210 in stock, exp 05 Jan 2027). Price difference: +₹2.00/tab.

✦ A cheaper same-composition option on a repeat line Draft — awaiting approval

Tab. Telmisartan 40mg is a standing line Lakshmi Devi refills monthly. The branded pack bills at ₹5.60 a tablet; the same composition from the Jan Aushadhi range bills at ₹1.35.

Option	Per tablet	30 days	Per year
Telma-40 (branded)	₹5.60	₹168.00	₹2,016
Telmisartan 40mg — Jan Aushadhi	₹1.35	₹40.50	₹486
The patient keeps	₹4.25	₹127.50	₹1,530

Identical composition and strength, both in stock. Cost of therapy is the patient's decision and the prescriber's to countersign — HOS shows the two prices and does not substitute anything on a repeat line by itself. On a pension, ₹1,530 a year is the difference between filling this prescription and skipping it.

Subtotal ₹515.00 GST @12% ₹61.80 Advance adjusted ₹0.00

Payable ₹576.80

Ward indents — dispensing against the IPD medication schedule

Batch-allocated by FEFO, credited back when nursing withholds a dose

3 indents today

Swipe the table sideways for the batch allocation.

Indent	Status	Ward / patient	Items	Round	Batch allocated
W-2026-0319	Awaiting pharmacy	General ward, Bed 7 — Ramesh Babu	Inj. Pantoprazole 40mg ×2 · IV Fluid RL 500ml ×3	12:00	—
W-2026-0318	Dispensed 09:26 · Ravi Teja	General ward, GM-05 — B. Srinu	Inj. Ceftriaxone 1g ×2 · Cap. Tramadol 50mg ×10	11:00 + 23:00	CEF-2402B FEFO · TRM-2405A
W-2026-0317	Returned 08:40 · dose withheld	General ward, GM-05 — B. Srinu	Inj. Ceftriaxone 1g ×1 (23:00 round, 17 Jul)	23:00 · 17 Jul	Credited back to CEF-2402B

Today HOS dispenses against the ward's medication schedule and records who dispensed, when, and from which batch — including the vial nursing sent back, which is where ward stock usually leaks. Barcode-verified administration at the bedside (closed-loop eMAR) is an R2 item and Administration → Compliance & NABH shows it as not yet live. This screen does not pretend otherwise.

✦ Pre-op staging drafted — D. Prakash, TKR Monday 09:00 Draft — awaiting approval

From Reception's admission record of 10:32 today and what the last total knee replacement consumed — B. Srinu, 15 Jul. Nothing has been reserved or issued.

To stage	Basis	Lot	Handling
Knee prosthesis set Consignment stock · femoral, tibial, insert	Procedure booked in Reception · package TKR-SEMI-3N	At point of use	Reserved against the case · UDI scanned in theatre, never before
Theatre pack — arthroplasty Drapes, gowns, suction, irrigation	Matches the 15 Jul TKR pack	On issue	Issued to OT-1 on Monday's indent
Post-op analgesia stock check H1	The 15 Jul TKR drew Schedule H1 lines from the ward indent	—	Register page prepared and left unsigned · quantities come from the order sheet

The last total knee replacement drew 12 pharmacy lines worth ₹9,510 across its stay. That is what this stages against — a count from your own record, not a protocol HOS invented. Which drugs D. Prakash receives, and in what dose, is on Dr. P. Anil Kumar's order sheet. HOS does not draft it and has not proposed one.

✦ Ward returns drafted — B. Srinu, discharging from GM-05 Draft — awaiting approval

Assembled from ward indent W-2026-0318 and the medication administration record. Quantities are issued-minus-administered — HOS has not moved any stock.

Item	Issued	Given	Returning	Batch	Handling
Inj. Ceftriaxone 1g CEF-2402B · ₹68.00	2	1	1	CEF-2402B	Back to shelf · ₹68.00 credited to the batch
Cap. Tramadol 50mg H1	10	7	3	TRM-2405A	Reversal entry in the H1 register — prescriber must be named

Indent W-2026-0318 issued 18 Jul, 09:26 AM by Ravi Teja — Ceftriaxone 1g ×2, Tramadol 50mg ×10, for the 11:00 and 23:00 rounds.
The 23:00 Ceftriaxone dose was not administered — the chart records a step-down from IV Ceftriaxone to oral Amoxicillin-Clav from Day 4 evening, so one vial is unopened.
7 of 10 Tramadol capsules are signed off on the administration record. The other 3 are still on the ward.
Tramadol 50mg is Schedule H1, so the return needs its own register entry against Dr. P. Anil Kumar (TSMC/41127) — not just a stock adjustment.
A separate vial already came back on W-2026-0317 (withheld 23:00 dose, 17 Jul) and was credited to CEF-2402B. It is not counted again here.

Sources: ward indent W-2026-0318 · medication administration record · H1 register (18 Jul, 09:26 AM) · IPD discharge summary · patient IP-2026-0442

No stock moves and no register entry is written until Ravi Teja approves.

Counter sale

Scan or search · FEFO picks the batch · bill no. PH-2026-0718-039 · Ravi Teja

0 items

Batch is chosen by FEFO from your own stock — the pharmacist can override, and the override is recorded.

Item	Batch · expiry	Qty	Rate	Amount
Nothing scanned yet. Press Scan to add the next item, or Load discharge Rx to pull a prescription.

MRP shown is inclusive of GST, as printed on the strip · nothing is billed until you take payment

✦ A scanned item is priced above its DPCO ceiling Draft — awaiting approval

Compared against the ceiling configured in your own Drug Master from the NPPA notification your pharmacist entered — HOS does not fetch a price from anywhere. Selling a scheduled formulation above its notified ceiling is an offence under the Drugs (Prices Control) Order, so the line cannot simply be discounted down: the rate itself is wrong.

₹ This discount is above counter authority Draft — awaiting approval

Counter authority is set in Administration at 10% or ₹500, whichever is lower. Above either, the bill waits for the owner — HOS does not raise the limit and does not apply the discount in the meantime.

Sales return

Against an original bill only — batch and expiry must match what was sold

Draft — awaiting approval Credit note CN-2026-0118

No bill, no return. A return without its original sale is an unaudited stock inward and a cash outflow with nothing behind it.

Bill

GST inclusive

Gross (MRP)₹0.00

DPCO ceiling correction₹0.00

Gross after correction₹0.00

Coupon₹0.00

Counter discount₹0.00

Rounding₹0.00

Net payable₹0.00

Taxable value (net ÷ 1.12)₹0.00

CGST 6%₹0.00

SGST 6%₹0.00

GST is extracted from the MRP, not added to it — the tax is already inside the printed price. Intra-state, so it splits CGST + SGST.

Coupon

Active this month: MONSOON50, SENIOR15, NEW200, LAB20

Discount

% of corrected gross

Counter authority 10% or ₹500, whichever is lower.

Payment

Tendered

Change due

₹0.00

A printed receipt is already valid — the sync only tells the server what happened. Writes are minted a local id before they are attempted.

Batch-wise stock register

64 SKUs · 10 batches shown

Swipe the table sideways for expiry, quantity and reorder point.

Drug	Status	Batch	Expiry	Qty on hand	Reorder pt.
Tab. Metformin 500mg	Healthy	MET-2411A	30 Sep 2026	420	150
Tab. Metformin 1000mg	Healthy	MET-2503B	31 Jan 2027	260	120
Tab. Telmisartan 40mg	Below reorder	TEL-2403C	12 Aug 2026	38	100
Tab. Amoxicillin-Clav 625mg	Healthy	AMC-2405B	05 Jan 2027	210	120
Syp. Ambroxol 100ml	Expiring soon + low	AMB-2402D	28 Jul 2026	54	60
Inj. Ceftriaxone 1g	Oldest batch — dispenses first	CEF-2402B	05 Sep 2026	40	80
Inj. Ceftriaxone 1g	Held behind CEF-2402B	CEF-2409A	14 Feb 2027	95	80
Tab. Pantoprazole 40mg	Healthy	PAN-2401E	09 Sep 2026	310	100
Tab. Azithromycin 500mg	Critical low	AZI-2406F	22 Oct 2026	18	50
Cap. Omeprazole 20mg	Healthy	OME-2403A	30 Nov 2026	140	90

7 batches expiring within 90 days (₹9,640 at risk) · 12 items below reorder point across all 64 SKUs · full exposure in Expiry & FEFO

✦ Reorder alert 12 below reorder point

12 items have fallen below their reorder point. Top priority by days-of-stock remaining:

Tab. Azithromycin 500mg18 left · reorder 50

Syp. Ambroxol 100ml54 left · reorder 60

Tab. Telmisartan 40mg38 left · reorder 100

+9 more itemsbelow threshold

A purchase order for all 12 items has been drafted — MedPlus Distributors, ₹48,200. It waits for Ravi Teja's approval in Purchase & GRN; nothing has been ordered.

Expiry exposure (≤90 days)

₹9,640

across 7 batches · 2 inside 30 days

Recoverable by vendor return

₹5,810

2 batches still inside MedPlus's 60-day window

Must move at the counter

₹3,830

return window already closed

Written off, last 12 months

₹41,200

0.49% of ₹84L purchased · trade norm 1–2%

Expiry exposure, batch by batch

At-risk value is the stock projected not to be dispensed before the batch expires — not the whole batch

Sorted by expiry date

Swipe the table sideways for projected use and at-risk value.

Drug & batch	Action	Expires	On hand	Will move first	At risk	At-risk value
Syp. Ambroxol 100ml AMB-2402D · ₹42.00	Move at counter	28 Jul 2026 · 10 days	54	12	42	₹1,764
Tab. Telmisartan 40mg TEL-2403C · ₹4.10	No action	12 Aug 2026 · 25 days	38	38	0	₹0
Inj. Ceftriaxone 1g CEF-2402B · ₹68.00	Move at counter	05 Sep 2026 · 49 days	40	12	28	₹1,904
Tab. Pantoprazole 40mg PAN-2401E · ₹3.60	Move at counter	09 Sep 2026 · 53 days	310	265	45	₹162
Inj. Human Insulin 40IU/ml INS-2404C · ₹185.00 · cold chain	Return to vendor	28 Sep 2026 · 72 days	24	8	16	₹2,960
Tab. Metformin 500mg MET-2411A · ₹1.10	No action	30 Sep 2026 · 74 days	420	420	0	₹0
Tab. Cefixime 200mg CFX-2404A · ₹15.00 · Schedule H1	Return to vendor	12 Oct 2026 · 86 days	260	70	190	₹2,850
Total exposure within 90 days — 7 batches					321	₹9,640

Two of these seven cost nothing: Telmisartan and Metformin 500mg will be fully dispensed before they expire, so flagging them as "at risk" would be a false alarm the pharmacist learns to ignore. ₹9,640 = ₹5,810 returnable + ₹3,830 that has to move over the counter.

✦ Near-expiry return to vendor — debit note draft DN-2026-0061 Draft — awaiting approval

MedPlus Distributors, contract clause 7: batches returned 60 days or more before expiry are credited at full invoice value; inside 60 days they are not accepted at all. Two batches qualify today and two have already fallen out of the window — which is the argument for alerting at 90 days rather than at 30.

Batch	Eligibility	Drug	Expires	Units	Credit
INS-2404C	Eligible · 72 days	Inj. Human Insulin 40IU/ml	28 Sep 2026	16	₹2,960
CFX-2404A	Eligible · 86 days	Tab. Cefixime 200mg	12 Oct 2026	190	₹2,850
CEF-2402B	Window closed 07 Jul	Inj. Ceftriaxone 1g	05 Sep 2026	28	—
AMB-2402D	Window closed 29 May	Syp. Ambroxol 100ml	28 Jul 2026	42	—
Credit recoverable on this debit note					₹5,810

Swipe the table sideways for expiry, units and credit.

Source: batch register + MedPlus purchase invoices PI-2026-0388 / PI-2026-0401 · return window from the vendor contract on file

FEFO at the point of dispense

First-expiry-first-out is enforced on the allocation, not left to whoever reaches the shelf

1 override blocked today

Swipe the table sideways for the alternative batches.

Item	Allocation	Against	Batch picked	Expires	Batches held back
Inj. Ceftriaxone 1g ×2	FEFO applied	Ward indent W-2026-0318 · B. Srinu, GM-05	CEF-2402B	05 Sep 2026	CEF-2409A (14 Feb 2027)
Tab. Telmisartan 40mg ×30	FEFO applied	Rx T-12 · Lakshmi Devi	TEL-2403C	12 Aug 2026	none — only batch in stock
Inj. Ceftriaxone 1g ×1	Override blocked	Counter sale 10:22 AM · newer batch selected by hand	CEF-2409A	14 Feb 2027	CEF-2402B (05 Sep 2026) must go first

Overriding FEFO is allowed — a damaged strip or a patient's own returned box are real reasons — but the reason is recorded against the dispense and the batch, so the exception is auditable rather than invisible.

FEFO, not FIFO: the batch that arrived first is not always the batch that dies first, and India's distribution reality — split deliveries, transfers between branches, patient returns — breaks arrival order routinely. HOS allocates on expiry date, and shows the batch it held back so the pharmacist can see the decision rather than trust it.

✦ Three inputs, not one run-rate Productivity tier · forecasts stock, never a patient

1 · Consumption base

90 days of dispense history per SKU, deseasonalised, single-day spikes trimmed. A raw 30-day run-rate in mid-July would carry the monsoon twice.

2 · Admissions pipeline

6 surgical admissions confirmed for the next 14 days in IPD, each with its standing consumables and antibiotic list. Ordered consumption, not guessed.

3 · Seasonality

This hospital's own monthly index, 2023–2025 — not a generic national curve. Kukatpally's monsoon is not Chennai's.

Source: 90-day MedicationDispense history · IPD admission schedule · 3-year monthly consumption index for this facility

Fever & analgesic group — this hospital's monthly index

1.00 = this facility's annual average. Mean of 2023, 2024 and 2025.

Next 30 days weight ×1.47

Swipe the chart sideways for the whole year.

0.72

Jan

0.66

Feb

0.74

Mar

0.81

Apr

0.87

May

1.03

Jun

1.35

Jul

1.58

Aug

1.46

Sep

1.07

Oct

0.79

Nov

0.92

Dec

The next 30 days straddle two months — 14 days of July at 1.35 and 16 days of August at 1.58, which weights to ×1.47. That is the multiplier applied to the fever and analgesic group below. Chronic-care and programme drugs get ×1.00: a diabetic's monthly refill does not know it is raining.

Projected 30-day demand — 18 Jul to 17 Aug

6 of 64 SKUs shown · days of cover is on-hand ÷ projected daily use

Days-of-cover ascending

Swipe the table sideways for on-hand stock and days of cover.

Drug	Action	Base	Adjustments	Projected	On hand	Days cover
Tab. Azithromycin 500mg	Raise to 400 on the PO	213	×1.47 season	313	18	1.7
IV Fluid RL 500ml	Add 400 to the PO	210	×1.47 season · +48 for 6 surgical admissions	357	165	14
Tab. Paracetamol 650mg	Add 2,000 to the PO	1,260	×1.47 season	1,852	1,180	19
Tab. Metformin 500mg	Reorder before 06 Aug	420	×1.00 chronic — no seasonality	420	420	30
Tab. 3-FDC (H+R+E) NTEP continuation phase · 7 patients × 28 tabs	Committed — hold cover	196	×1.00 · programme commitment, not a forecast	196	224	34
Inj. Ceftriaxone 1g	Cut PO line 150 → 60	68	×1.00 · +36 for 6 surgical admissions	104	135	39

Metformin 500mg reads as comfortable at 30 days of cover and is not. At 14 tablets a day it crosses its 150-tablet safety buffer on 06 Aug — 19 days out, which is inside MedPlus's lead time plus a weekend. Days-of-cover alone would have missed it; the buffer is what catches it. 3-FDC is not forecast at all — 7 patients in NTEP continuation phase is a commitment, and a TB patient who misses a refill is a treatment failure, so this SKU is never allowed to dip.

✦ Forecast revision to PO-2026-0714 Draft — awaiting approval

The purchase order drafted from reorder levels alone buys the wrong things. Four lines change:

Line	Change	Why	Rate	Value
Inj. Ceftriaxone 1g	150 → 60	39 days of cover already on hand across two batches; the older one expires 05 Sep	₹68.00	−₹6,120
Tab. Azithromycin 500mg	300 → 400	1.7 days of cover against a ×1.47 monsoon weight	₹8.20	+₹820
Tab. Paracetamol 650mg	0 → 2,000	Not on the PO at all — reorder level was never breached, but 19 days of cover runs out inside the August peak	₹0.62	+₹1,240
IV Fluid RL 500ml	0 → 400	14 days of cover with 6 surgical admissions already scheduled	₹22.50	+₹9,000
Net change · PO-2026-0714 goes ₹48,200 → ₹53,140				+₹4,940

Swipe the table sideways for the rate and rupee value of each change.

Source: 90-day dispense history · IPD admission schedule (6 cases, 14 days) · 3-year monthly index · MedPlus rate card

Forecast accuracy — last 6 months

Mean absolute percentage error by group. The worst number is shown, not the best.

n = 2,184 SKU-months

Chronic-care refills — Metformin, Telmisartan, statins 6.2%

Surgical consumables — driven by the admission list; misses when a case is cancelled 11.4%

Fever & analgesic group — the monsoon peak's size is predictable, its start date moves by up to 3 weeks 19.8%

Injectable antibiotics — worst group; choice varies with which consultant is on duty 23.1%

ADR #7 asks for confidence calibration displayed where the AI is shaky, not just where it is confident. Injectable antibiotics are shaky — 23.1% error means a 150-vial order could be 35 vials wrong either way, which is why that line came to you as a proposal rather than a placed order.

✦ Purchase order draft — PO-2026-0714 Draft — awaiting approval

Vendor MedPlus Distributors GSTIN 36AAECM1122G1ZQ Items 12 Total ₹48,200 Drafted from reorder alerts, Stock & Batches tab

Drug	Qty ordered	Unit rate	Line total
Tab. Azithromycin 500mg	300	₹8.20	₹2,460
Syp. Ambroxol 100ml	100	₹42.00	₹4,200
Tab. Telmisartan 40mg	500	₹4.10	₹2,050
Inj. Ceftriaxone 1g	150	₹68.00	₹10,200
Tab. Pantoprazole 40mg	600	₹3.60	₹2,160
Tab. Metformin 500mg	1000	₹1.10	₹1,100
+ 6 more items (Amoxicillin-Clav 625mg, Omeprazole 20mg, and others)			₹26,030
Grand total			₹48,200

MP MedPlus Distributors Vendor

Goods Received Note

Entry form

Purchase order

PO-2026-0714 preview — MedPlus Distributors · GSTIN 36AAECM1122G1ZQ · 12 items · ₹48,200 total

GRN date

Items received

Tab. Azithromycin 500mgOrdered 300

Qty received

Batch no.

Expiry date

Syp. Ambroxol 100mlOrdered 100

Qty received

Batch no.

Expiry date

Inj. Ceftriaxone 1gOrdered 150

Qty received

Batch no.

Expiry date

Vendor credit outstanding

₹8,150 not yet credited

DN-2026-0061 MedPlus Distributors ₹5,810 near-expiry return · raised 12 Jul 6 days outstanding

DN-2026-0048 Sri Sai Pharma Agencies ₹2,340 short supply on GRN · raised 28 Jun 20 days outstanding

DN-2026-0039 MedPlus Distributors ₹1,150 damaged in transit · raised 14 Jun credited 22 Jun

A debit note raised is a claim; a credit note received is money. HOS now tracks the gap — ₹8,150 has been claimed and not yet returned, the oldest of it 20 days ago.

✦ An invoiced rate is above your rate contract Draft — awaiting approval

MedPlus invoiced Inj. Ceftriaxone 1g at ₹68.00 on the 14 Jul GRN. Your rate contract with them fixes it at ₹64.00 until 30 Sep 2026. On the 150 units of PO-2026-0714 that is ₹600 above contract.

Drug	Contract rate	Invoiced	MRP	Margin	Status
Inj. Ceftriaxone 1g	₹64.00	₹68.00	₹87.60	22.4%	₹4.00 over
Tab. Azithromycin 500mg	₹8.20	₹8.20	₹10.50	21.9%	On contract
Tab. Telmisartan 40mg	₹4.10	₹4.10	₹5.28	22.3%	On contract
Syp. Ambroxol 100ml	₹42.00	₹42.00	₹54.00	22.2%	On contract

Compared against the signed rate contract in your own vendor master, not a market reference. Note the Telmisartan MRP shown here is the corrected ₹5.28 ceiling — the ₹5.60 currently on the shelf label is the breach flagged in Statutory Registers.

Fill rate · last 30 days

97.4%

3,331 of 3,420 lines dispensed

Lines refused

89

across 5 SKUs · 20 store-days out

Revenue that left the building

₹13,678

1.75% of counter revenue

Gross margin forgone

₹3,064

at your 22.4% pharmacy margin

Lines the counter could not fill

19 Jun – 18 Jul 2026

Swipe sideways for days out, line value and the cause.

Drug	Lines refused	Avg line value	Revenue lost	Days out	Why it ran out
Inj. Ceftriaxone 1g	14	₹438	₹6,132	3 days	FEFO held the newer batch behind CEF-2402B while the older one ran down
Tab. Telmisartan 40mg	26	₹128	₹3,328	5 days	Reorder point of 100 is below a 5-day lead time at this rate of sale
Tab. Azithromycin 500mg	22	₹105	₹2,310	6 days	Longest outage of the month — still below reorder today at 18 units
Syp. Ambroxol 100ml	18	₹58	₹1,044	4 days	Monsoon demand ×1.47 against a reorder point set in summer
Inj. Pantoprazole 40mg	9	₹96	₹864	2 days	Ward floor stock drew 40 units the same morning a PO was pending
5 SKUs	89	—	₹13,678	20 store-days

Every line here was a prescription presented at your counter and turned away. The rupee figure is what it would have billed at your own rates — not a projection. Four of the five SKUs are still below reorder point today.

Fill rate

97.4% of lines filled

3,420 lines presented over 30 days (38 bills a day, 3 lines a bill). 89 could not be filled — a 2.6% miss. Your own best month in the last six was 98.9%.

A fill rate is the one pharmacy number a patient feels directly. They do not see your margin or your expiry write-offs; they see whether they had to go somewhere else.

✦ Reorder points that caused the outages Draft — awaiting approval

Three of the five outages happened while the SKU was above its reorder point when the order should have gone out — the point itself is set too low for the lead time.

Tab. Telmisartan 40mg100 → 180

Tab. Azithromycin 500mg50 → 120

Syp. Ambroxol 100ml60 → 110

Computed from your own 30-day rate of sale × MedPlus's own 5-day lead time, with the monsoon index already applied. Raising these three ties up an extra ₹4,180 of working capital against ₹6,682 of revenue that walked out in one month.

Stock by location

₹8.4L across 5 stores

Main pharmacyMAIN · Ravi Teja

₹6,80,000

OT storeOTS · Sister Anasuya Rani

₹78,000

Ward floor stockWRD · Mary Grace

₹42,000

Emergency storeEMG · Staff Nurse Jyothi

₹22,000

ICU crash cartICU · sealed · Mary Grace

₹18,000

Each store has a named custodian, because stock nobody owns is stock nobody counts. The crash cart is sealed — it is checked against its seal, not counted item by item.

Stock that left the main store today

18 Jul 2026

Dispensed to a patient

₹23,140

38 bills. This is revenue — the stock is gone and money came in against it.

Issued to a sub-store

₹11,400

7 indents. This is a transfer — still your stock, in a different cupboard, and not yet a sale.

A single “stock out the door” figure would report ₹34,540 today and read as sales. Only ₹23,140 of it was sold. Conflating an issue with a dispense is the most common reason a hospital's pharmacy stock never reconciles, and why a ward return has nothing to reconcile against.

Transfers awaiting your approval

2 pending

To store	Requested by	Items	Value	Action
Ward floor stock WRD	Mary Grace	Inj. Ceftriaxone 1g ×10 · Tab. Pantoprazole 40mg ×40	₹824
OT store OTS	Sister Anasuya Rani	Inj. Tramadol 50mg ×6 — NDPS, needs register entry	₹87

Ward and theatre consumption is recorded where it happens — Nursing and Operation Theatre own those ledgers. This screen owns the transfer out of the main store, and nothing more.

Last count

15 Jul

A-class · 12 SKUs · counted by Ravi Teja

SKUs with a variance

4

of 12 counted · 8 matched exactly

Net variance

−₹263

₹347 absolute movement

Next count due

22 Jul

A-class · weekly cycle

Cycle count — A-class, 15 Jul 2026

signed off 15 Jul, 07:20 PM

Swipe sideways for the four-count trend.

Drug	System	Counted	Variance	Value	Last 4 counts
Inj. Ceftriaxone 1g	135	131	−4	−₹272.00	−4−3−5−4
Inj. Tramadol 50mg	48	46	−2	−₹29.00	−20−10
Tab. Metformin 500mg	420	416	−4	−₹4.40	−4+6−3+2
Syp. Ambroxol 100ml	54	55	+1	+₹42.00	+100−1
8 further A-class SKUs counted, all matched system stock exactly
Net	—	—	—	−₹263.40

Counted by Ravi Teja, signed off by Dr. G. Prakash. A count with one signature is a count nobody checked, so HOS will not close one without a second name.

✦ Two of these four look different from each other Draft — awaiting approval

Inj. Ceftriaxone 1g has recorded a shortfall in all four of the last counts — −4, −3, −5, −4, or 16 vials and ₹1,088 over four weeks. A discrepancy that keeps the same sign is not arithmetic noise.

Tab. Metformin 500mg moved −4, +6, −3, +2 across the same four counts. It alternates sign and nets to +1, which is what a hand-counted 420-tablet line looks like.

Four consecutive A-class counts, this store only. HOS is reporting the arithmetic and the sign pattern. What it means is yours to determine — a persistent shortfall can be wastage, an unrecorded ward issue, a batch received short, or a count method that needs changing. HOS does not attribute cause and does not name anyone.

The counting cycle

64 SKUs

Class	SKUs	Frequency	Basis	Next due
A	12	Weekly	Injectables, NDPS and anything above ₹50 a unit	22 Jul 2026
B	22	Monthly	Regular movers below ₹50 a unit	01 Aug 2026
C	30	Quarterly	Slow movers and consumables	30 Sep 2026

An annual stock-take finds a year-old discrepancy nobody can explain. A weekly count on the twelve lines that carry the value finds it while the answer is still in living memory.

✦ One scheduled drug is priced above its ceiling Draft — awaiting approval

Tab. Telmisartan 40mg is recorded at ₹5.60 against a configured ceiling of ₹5.28 — over by ₹0.32 a tablet. Selling a scheduled formulation above its notified ceiling is an offence under the Drugs (Prices Control) Order, not a pricing choice.

Scheduled drug	Configured ceiling	Recorded MRP	Status
Tab. Telmisartan 40mg	₹5.28	₹5.60	Over by ₹0.32
Tab. Metformin 500mg	₹1.63	₹1.42	Within ceiling
Tab. Pantoprazole 40mg	₹4.98	₹4.65	Within ceiling
Tab. Azithromycin 500mg	₹11.87	₹10.50	Within ceiling
Inj. Ceftriaxone 1g	₹94.20	₹87.60	Within ceiling

Ceilings are the ones configured in your Drug Master from the NPPA notification your pharmacist entered — HOS compares against your own configured figure and does not fetch a price from anywhere. 214 units have been sold since the ceiling was last changed on 01 Jul, so ₹68 is refundable, and 38 units on the shelf carry ₹12 of further exposure. The rupees are small; the penalty for the breach is not.

NDPS register — Inj. Fentanyl 50mcg/ml

18 Jul 2026 · pharmacist-in-charge Ravi Teja

Opening

24

Received

0

Issued

4

Returned

0

Closing

20

24 − 4 = 20. The physical count in the DDA cupboard matched at 20 ampoules.

Time	Movement	Case / authority	Ampoules	Balance
07:00	Opening balance	Verified against DDA cupboard seal	—	24
08:42	Issued to OT-1	OT-1/18JUL/02 · Dr. M. Yugandhar, anaesthetist	4	20
11:26	Administered	3 ampoules complete · 1 part-used, 0.6ml of 2.0ml given	—	20
11:28	Wastage — 1.4ml	Balance of the part-used ampoule, discarded in theatre	—	20

Ampoule-level accounting, because a register that balances only in whole ampoules cannot account for a part-used one — and the part-used ampoule is the entire point of a narcotics register.

✦ Wastage entry drafted — awaiting the second signature Draft — awaiting sign-off

1.4ml of Inj. Fentanyl 50mcg/ml was discarded in OT-1 at 11:28 from a part-used ampoule. NDPS wastage needs two names, and the second cannot be the pharmacist who issued it — the register already carries Ravi Teja as the issuer.

Drafted from the theatre record: case OT-1/18JUL/02, 0.6ml of a 2.0ml ampoule administered, balance discarded. Dr. M. Yugandhar administered and must attest to the discard. The entry stays open in the register until he does.

Open the theatre record →

Verified formulary

Licensed, not hand-typed — composition, HSN, GST rate, substitutes and drug schedule arrive with the record

Licensed national medicine database Synced 04:15 AM

16 of 16

Swipe the table sideways for HSN, GST rate and substitutes.

Drug name	Schedule	Composition	HSN	GST%	Substitutes in stock
Tab. Metformin 500mg	H	Metformin Hydrochloride 500mg	30049099	12%	Glycomet 500, Glyciphage 500
Tab. Metformin 1000mg	H	Metformin Hydrochloride 1000mg	30049099	12%	Glycomet 1000, Gluformin XL 1000
Tab. Telmisartan 40mg	H	Telmisartan 40mg	30049099	12%	Telma 40, Telsartan 40
Tab. Amoxicillin-Clav 625mg	H	Amoxicillin 500mg + Clavulanic Acid 125mg	30041000	12%	Moxikind-CV 625 (Augmentin 625 Duo — 0 in stock)
Syp. Ambroxol 100ml	H	Ambroxol Hydrochloride 30mg/5ml	30049099	12%	Ambrolite, Mucolite
Inj. Ceftriaxone 1g	H	Ceftriaxone Sodium 1g (IV/IM)	30041000	12%	Monocef 1g, Intacef 1g
Tab. Pantoprazole 40mg	H	Pantoprazole Sodium 40mg	30049099	12%	Pantocid 40, Pantop 40
Tab. Azithromycin 500mg	H	Azithromycin 500mg	30041000	12%	Azithral 500, Zady 500
Cap. Omeprazole 20mg	H	Omeprazole 20mg	30049099	12%	Omez 20, Ocid 20
Inj. Human Insulin 40IU/ml	H	Human Insulin (rDNA) 40IU/ml, 10ml vial	30043900	5%	Huminsulin R, Actrapid
Tab. Paracetamol 650mg	OTC	Paracetamol 650mg	30049099	12%	Dolo 650, Calpol 650
Tab. Cefixime 200mg	H1	Cefixime 200mg	30041000	12%	Taxim-O 200, Zifi 200
Cap. Tramadol 50mg	H1	Tramadol Hydrochloride 50mg	30049099	12%	Tramazac 50, Domadol 50
Tab. Alprazolam 0.5mg	H1	Alprazolam 0.5mg	30049099	12%	Alprax 0.5, Restyl 0.5
Tab. 3-FDC (H+R+E)	H1	Isoniazid 300mg + Rifampicin 450mg + Ethambutol 800mg	30042000	12%	NTEP programme supply — not purchased
Inj. Ketamine 50mg/ml	X	Ketamine Hydrochloride 50mg/ml	30049099	12%	Ketmin 50, Aneket

Licensed from a national medicine database of 4.5 lakh formulations; 11,400 are indexed for this hospital's specialities, 64 SKUs are enabled and physically stocked, and 16 of those are listed above. Nobody typed any of it — per research/09, a hospital pharmacist will not hand-enter a formulary, and a formulary with a wrong HSN or GST rate produces a wrong invoice on every single sale.

Schedule H1 & X register

Written from the dispense record — there is no second book to keep

Under the Drugs & Cosmetics Rules, a Schedule H1 drug must be entered in a separate register recording the patient, the prescriber, the drug, the quantity and the date, and that register must be retained for three years. Schedule X additionally requires the prescription copy to be kept for two years. HOS writes both from the dispense itself — and a Schedule H1 line cannot be dispensed until a prescriber name and registration number are on the record, which is the part a paper register cannot enforce.

Swipe the table sideways for prescriber and dispensing pharmacist.

Date & time	Drug	Batch	Qty	Patient	Prescriber (reg. no.)	Dispensed by
18 Jul 2026, 09:26 AM	Cap. Tramadol 50mg H1	TRM-2405A	10	B. Srinu IP-2026-0442	Dr. P. Anil Kumar TSMC/41127	Ravi Teja
17 Jul 2026, 06:12 PM	Tab. Alprazolam 0.5mg H1	ALP-2503C	10	Ramesh Babu OP-2026-3318	Dr. K. Ramesh TSMC/28904	Swapna
17 Jul 2026, 11:04 AM	Tab. Cefixime 200mg H1	CFX-2404A	10	Fathima Begum OP-2026-3301	Dr. Sunitha Rao TSMC/33562	Ravi Teja
16 Jul 2026, 04:48 PM	Inj. Ketamine 50mg/ml X	KET-2412B	2	B. Srinu IP-2026-0442	Dr. P. Anil Kumar TSMC/41127	Ravi Teja witness: Sr. Mary Grace

3 Schedule H1 entries and 1 Schedule X entry in the last 48 hours · H1 register retained 3 years, Schedule X prescription copies retained 2 years · exportable as a single PDF for a drug-inspector visit. The ₹192-a-month app the pharmacist's cousin uses already does this; a ₹35,000-a-month hospital OS that does not would lose the argument in the room.