Gornez, Althia M.

HRN: 23-60-40  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
08/26/2023
CEFTRIAXONE 1G (VIAL)
08/26/2023
09/02/2023
IV
2g
OD
UTI In Pregnancy
Waiting Final Action 
08/26/2023
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
08/26/2023
09/01/2023
IV
375 Mg
Q12
UTI In Pregnancy
Rejected 
08/26/2023
METRONIDAZOLE 500MG (TAB)
08/26/2023
09/01/2023
ORAL
500mg
TID
T/c Ruptured Appendicitis
Checking Final Appropriateness 
08/27/2023
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
08/27/2023
08/31/2023
IV
1.5gm
Q6hrs
T/C Acute Pyelonephritis Vs Acute Appendicitis
Waiting Final Action 
08/27/2023
METRONIDAZOLE 5MG/ML, 100ML (VIAL)
08/27/2023
08/31/2023
IV
500mg
Q8hrs
T/C Acute Pyelonephritis Vs Acute Appendicitis
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: