Tagactac, Placidad D.

HRN: 24-18-70  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/07/2023
ACICLOVIR 800MG (TAB)
12/07/2023
12/13/2023
PO
800mg
5x A Day
Herpes Zoster Ophthalmicus
Checking Final Appropriateness 
12/07/2023
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
12/07/2023
12/13/2023
IVT
1.5g
Q6
Herpes Zoster Ophthalmicus; Soft Tissue Infection
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: