Alpha, Fitriana .

HRN: 19-24-41  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/08/2024
AMPICILLIN 1GM (VIAL)
01/08/2024
01/15/2024
IV
500mg
Q12h
PCAP B
Waiting Final Action 
01/08/2024
AMPICILLIN 1GM (VIAL)
01/08/2024
01/14/2024
IV
250mg
Q6H
PCAP B
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: