Dictahan, Baby Boy C.

HRN: 25-57-61  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/31/2024
AMPICILLIN 250MG (VIAL)
07/31/2024
08/07/2024
IV
215mg
Q12
PSNB
Waiting Final Action 
07/31/2024
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
07/31/2024
08/07/2024
IV
50mg
Q24
PSNB
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: