Israel, Baby Boy .

HRN: 23-24-12  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/28/2023
AMPICILLIN 250MG (VIAL)
06/28/2023
07/05/2023
IV
160mg
Q12
Potential Septic Newborn
Waiting Final Action 
06/28/2023
GENTAMICIN 40MG/ML, 2ML (AMP)
06/28/2023
07/12/2023
IV
16mg
Q24h
Potential Septic Newborn
Waiting Final Action 

AMS Audit Form


Start Date: End Date:

Indication:

              

Type of Infection:

                             

           

Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: