Catalogo, Beathany Brielle .

HRN: 23-24-15  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
08/25/2023
AMPICILLIN 1GM (VIAL)
08/25/2023
09/01/2023
IVTT
250mg
Q6
PCAP C
Checking Final Appropriateness 
08/25/2023
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
08/25/2023
09/01/2023
IVTT
60mg
Q24
PCAP C
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: