Lascoña, Kyver Clayton A.

HRN: 22-24-02  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/27/2023
AMPICILLIN 1GM (VIAL)
07/27/2023
08/03/2023
IV
350mg
Q6H
PCAP
Checking Final Appropriateness 
07/29/2023
AZITHROMYCIN 200MG/5ML, 15ML SUSPENSION (SUSP)
07/29/2023
08/02/2023
PO
2.5ml Then 1ml
OD
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: