Product List - for Data Entry - Giving to the Nations Racine

Healthy Essentials Product List (#23)

OFFICE USE ONLY

System Assigned Date

Is this client already in the database?

Yes

Original Submission ID

Request Date

Entered By

CLIENT INFORMATION

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

ADULT PERSONAL CARE ITEMS

Deordorant Male

Deordorant Female

Shampoo

Conditioner

Bar Soap

Hand Soap

Hand Sanitizer

Shaving Cream Male

Shaving Cream Female

Razors Male

Razors Female

Body Wash

Body Lotion

Adult Briefs Male

Adult Briefs Female

Bandages

Antibiotic Ointment

Brush

Comb

FEMININE HYGIENE PRODUCTS

Pantiliners

Pads

Tampons

DENTAL CARE ITEMS

Toothbrush Adult

Toothbrush Child

Toothpaste

Dental Floss

BABY PERSONAL CARE ITEMS

Diaper Size-1st choice

Diaper Size-2nd choice

Diaper Size-3rd choice

Baby Wipes

Baby Ointment

Baby Wash (shampoo/bath)

Baby Lotion

HOUSEHOLD CLEANING PRODUCTS

Dishwashing Detergent

Multi-purpose Cleaner

Disinfecting Wipes

Bleach

Storage Bags - Sandwich

Storage Bags - Quart

Storage Bags - Gallon

Tissues

Trash Bags-13 Gallon

Paper Towels

Toilet Paper

Laundry Detergent

Dryer Sheets

OTHER

Filled By

Fill Date

Product List – for Data Entry

OFFICE USE ONLY

CLIENT INFORMATION

Volunteer to help

Connect with us