Roma, Rasma G.

HRN: 21-65-67  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/31/2022
AMPICILLIN 1GM (VIAL)
07/31/2022
08/01/2022
IVT
2gms
Q6H
G1P0 36 3/7; PPROM X 8HRS
Waiting Final Action 
07/31/2022
CEFUROXIME 500MG (TAB)
07/31/2022
08/07/2022
ORAL
500mg/tab
BID
S/P NSVD; UTI
Waiting Final Action 
07/31/2022
AZITHROMYCIN 500MG TABLET (TAB)
07/31/2022
08/04/2022
ORAL
500mg/tab
OD
CAP MR
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: