Bersada, Maxima A.

HRN: 26 61 81  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/29/2025
CEFTRIAXONE 1G (VIAL)
01/29/2025
02/04/2025
IV
2gm
OD
Cap
Waiting Final Action 
01/29/2025
AZITHROMYCIN 500MG TABLET (TAB)
01/29/2025
02/02/2025
PO
500mg
OD
Cap
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: