Gomez, Baby Girl G.

HRN: 35  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/08/2022
AMPICILLIN 250MG (VIAL)
04/08/2022
04/15/2022
IV
168mg
Q12h
PSNB
Waiting Final Action 
04/08/2022
GENTAMICIN 40MG/ML, 2ML (AMP)
04/08/2022
04/15/2022
IV
16.8mg
Q24h
PSNB
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: