Basilisco, Constancio P.

HRN: 24-35-75  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/27/2023
CEFTRIAXONE 1G (VIAL)
12/27/2023
01/02/2024
IV
2gm
OD
CAP
Checking Final Appropriateness 
12/27/2023
AZITHROMYCIN 500MG TABLET (TAB)
12/27/2023
12/31/2023
PO
500mg
OD
CAP
Checking Final Appropriateness 
12/27/2023
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
12/27/2023
01/02/2024
IV
1.5 Grams
Q 6 Hrs
Cap
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: