Maulana, Esrafel Aiyaz B.

HRN: 21-50-74  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
09/21/2023
CEFTRIAXONE 1G (VIAL)
09/21/2023
09/28/2023
IV DRIP
1g
OD
PCAP C
Waiting Final Action 
09/21/2023
AMOXICILLIN 250MG/5ML, 60ML SUSPENSION (BOT)
09/21/2023
10/05/2023
ORAL
5.5ml
TID
H Pylori Infection
Waiting Final Action 
09/21/2023
CLARITHROMYCIN 125MG/5ML, 60ML SUSPENSION (BOT)
09/21/2023
10/05/2023
ORAL
2.8ml
BID
H Pylori Infection
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: