Balok, Bby Girl .

HRN: 22-39-91  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/18/2023
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
05/18/2023
05/25/2023
IVTT
130mg
Q6
Pneumonia Very Severe
Checking Final Appropriateness 
05/18/2023
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
05/18/2023
05/25/2023
IVTT
80mg
Q24
Pcap
Checking Final Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

Type of Infection:

                             

           

Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: