Ricafrente, Roel Jr .

HRN: 26-33-29  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/04/2024
AMPICILLIN 1GM (VIAL)
12/04/2024
12/11/2024
IV
500mg
Q6h
Pcap C
Waiting Final Action 
12/04/2024
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
12/04/2024
12/11/2024
IV
150mg
Q24hrs
Pcap C
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: