Ornillo, Zavier Kaleb D.

HRN: 26-13-89  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/25/2024
AMPICILLIN 250MG (VIAL)
12/25/2024
01/01/2025
IV
150mg
Q12H
PCAP
Waiting Final Action 
12/25/2024
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
12/25/2024
01/01/2025
IV
45mg
Q24H
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: