Dalansay, Maria Teresa C.

HRN: 08-53-46  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
09/12/2023
CEFTRIAXONE 1G (VIAL)
09/12/2023
09/18/2023
IV
2gm
Q24H
UTI
Checking Final Appropriateness 
09/12/2023
CIPROFLOXACIN 500MG (TAB)
09/12/2023
09/18/2023
PO
500mg
BID
AGE
Checking Final Appropriateness 
09/13/2023
METRONIDAZOLE 5MG/ML, 100ML (VIAL)
09/13/2023
09/20/2023
IV
500mg
Q8H
Infectious Diarrhea
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: