Timbang, Baby Boy .

HRN: 26-60-32  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/31/2025
AMPICILLIN 500MG (VIAL)
01/31/2025
02/06/2025
IVT
200mg
Q12
Sepsis
Checking Final Appropriateness 
01/31/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
01/31/2025
02/06/2025
IVT
30mg
Q24
Sepsis
Checking Final Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

Type of Infection:

                             

           

Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: