Templa, Niceforo P.

HRN: 21-51-29  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
11/27/2023
CEFTRIAXONE 1G (VIAL)
11/27/2023
12/03/2023
IV
2 Grams
OD
Cap Mr
Waiting Final Action 
11/27/2023
AZITHROMYCIN 500MG TABLET (TAB)
11/27/2023
12/01/2023
PO
500 Mg
OD
Cap
Checking Final Appropriateness 
11/27/2023
LEVOFLOXACIN 5MG/ML, 100ML (VIAL)
11/27/2023
12/01/2023
IV
500 Mg
OD
Cap
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: