Ermac, Danna L.

HRN: 24-59-06  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/27/2024
AMPICILLIN 500MG (VIAL)
03/27/2024
04/03/2024
IV
300mg
Q6H
T/C CNS Infection
Checking Final Appropriateness 
03/27/2024
GENTAMICIN 40MG/ML, 2ML (AMP)
03/27/2024
04/03/2024
IV
10mg
Q8H
T/C CNS Infection
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: