Mabeza, Ronalyn M.

HRN: 24-15-92  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/06/2024
AMPICILLIN 1GM (VIAL)
01/06/2024
01/12/2024
IV
2 Grams
Q6
PROM 4 Hrs
Checking Final Appropriateness 
01/07/2024
CO-AMOXICLAV 625MG (TAB)
01/07/2024
01/13/2024
PO
1tab
BID
Rmle
Checking Final Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



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Overall appropriateness: