Domolon, Esmiraldo G.

HRN: 24-97-00  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/02/2024
CO-AMOXICLAV 625MG (TAB)
05/02/2024
05/09/2024
PER OREM
1 Tablet
Once Every 12 Hours
CAP LR
Waiting Final Action 
05/04/2024
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
05/04/2024
05/13/2024
IV
4.5g
Q8
T/C Acute Cholangitis
Waiting Final Action 
05/04/2024
METRONIDAZOLE 5MG/ML, 100ML (VIAL)
05/04/2024
05/13/2024
IV
500mg
Q8
T/C Acute Cholangitis
Waiting Final Action 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: