Monsanto, Baby Girl .

HRN: 23-96-22  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
10/31/2023
AMPICILLIN 500MG (VIAL)
10/31/2023
11/06/2023
IVT
200mg
Q12
Sepsis
Checking Final Appropriateness 
10/31/2023
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
10/31/2023
11/06/2023
IVT
60mg
Q24
Sepsis
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: