Jacalan, Amarcita B.

HRN: 26-73-75  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/02/2025
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
03/02/2025
03/08/2025
IV
1.5gm
Q6
Intraabdominal Infection
Waiting Final Action 
03/02/2025
METRONIDAZOLE 5MG/ML, 100ML (VIAL)
03/02/2025
03/08/2025
IV
500mg
Q6
Intraabdominal Infection
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: