Dela Cruz, Rosalita T.

HRN: 01-58-30  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/04/2022
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
06/04/2022
06/11/2022
IV
4.5gm
Q6
Septic Shock, Generalized Peritonitis; R/O Perforated BPUD
Waiting Final Action 
06/04/2022
METRONIDAZOLE 5MG/ML, 100ML (VIAL)
06/04/2022
06/11/2022
IV
500mg
Q6
Septic Shock, Generalized Peritonitis; R/O Perforated BPUD
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: