Mogalin, Heart Shane T.

HRN: 21-22-47  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/04/2024
AMPICILLIN 1GM (VIAL)
01/04/2024
01/11/2024
IV
240mg
Q6H
PCAP B
Checking Final Appropriateness 
01/06/2024
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
01/06/2024
01/12/2024
IVT
250mg
Q6hrs
Pcap B
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: