Dirige, Baby Boy .

HRN: 23-76-97  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
10/14/2023
AMPICILLIN 250MG (VIAL)
10/14/2023
10/21/2023
IV
160
Q12
PSNB
Waiting Final Action 
10/14/2023
GENTAMICIN 40MG/ML, 2ML (AMP)
10/14/2023
10/21/2023
IV
16
Q24
PSNB
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: