Health Facility

District

Requested Commodity

Quantity Requested

Quantity Dispatched {{ Form::text('qty_dispatched', Input::old('qty_dispatched'), array('class' => 'form-control', 'rows' => '2', 'required')) }}

Comment

{{ Form::label('start_date', 'Dispatch Date:') }} {{ Form::text('dispatch_date', Input::old('dispatch_date'),array('class' => 'form-control standard-datepicker','required'=>'required','id'=>'start_date')) }}

Dispatched By