Baldapan, Joana .

HRN: 23-58-73  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/11/2025
AMPICILLIN 250MG (VIAL)
03/11/2025
03/18/2025
IV
200
Q6
Tracheostomy Tube Dislodgement
Waiting Final Action 
03/11/2025
CEFTRIAXONE 1G (VIAL)
03/11/2025
03/18/2025
IV
540mg
Q24hours
PCAP-D
Waiting Final Action 
03/15/2025
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
03/15/2025
03/31/2025
IVT
270mg
Q6
PCAP-D
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: