Bicalas, Eliasem N.

HRN: 19-04-70  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
10/18/2023
AZITHROMYCIN 500MG TABLET (TAB)
10/18/2023
10/23/2023
PO
500mg
OD
CAP MR
Checking Final Appropriateness 
10/18/2023
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
10/18/2023
10/25/2023
IV
1.5gms
Q6
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: