Pocong, Erlinda G.

HRN: 20-94-64  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
10/08/2023
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
10/08/2023
10/15/2023
IV
1.5g
Q8
CAP-MR
Checking Final Appropriateness 
10/08/2023
AZITHROMYCIN 500MG TABLET (TAB)
10/08/2023
10/12/2023
PO
500mg
OD
CAP-MR
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: