Matondac, Winz Y.

HRN: 21-45-89  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/09/2022
AMPICILLIN 500MG (VIAL)
06/09/2022
06/15/2022
IVT
475mg
Q12
Age With Moderate Dehydration
06/09/2022
GENTAMICIN 40MG/ML, 2ML (AMP)
06/09/2022
06/15/2022
IVT
48mg
Q24
Age In Moderate Dehydration
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: