Tina, Aliyah E.

HRN: 21-52-51  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/04/2022
AMPICILLIN 500MG (VIAL)
07/04/2022
07/11/2022
IV
220mg
Q6
Urti, T/c Uti With Mild Dehydration
Waiting Final Action 
07/09/2022
CEFUROXIME 1.5GM (VIAL)
07/09/2022
07/14/2022
IVT
290
Q8
Pcap B
Waiting Final Action 
07/09/2022
AZITHROMYCIN 200MG/5ML, 15ML SUSPENSION (SUSP)
07/09/2022
07/16/2022
PO
1.7ml
OD X 3 Days
Pcap
Waiting Final Action 

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: