Oling, Reysel Vienne -.

HRN: 17-52-82  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/22/2022
AMPICILLIN 250MG (VIAL)
06/22/2022
06/29/2022
IV
250mg
Q6
Pcap C
06/22/2022
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
06/22/2022
06/29/2022
IV
120mg
Q24
Pcap C
Waiting Final Action 
06/23/2022
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
06/23/2022
06/29/2022
IVT
250mg
Q6
PCAP C
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: