Tam, Donna C.

HRN: 23-13-29  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/05/2023
AMPICILLIN 500MG (VIAL)
06/06/2023
06/13/2023
IVTT
150mg
Q6
UTI
Waiting Final Action 
07/26/2023
CEFUROXIME 750MG (VIAL)
07/26/2023
08/02/2023
IV
180mg
Q8
AGE
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: