Landong, Brinlie Jazz A.

HRN: 26-87-91  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/30/2025
AMPICILLIN 250MG (VIAL)
03/30/2025
04/06/2025
IV
300mg
Q 12
PCAP C
Waiting Final Action 
03/30/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
03/30/2025
04/06/2025
IV
65mg
Q 24
PCAP C
Waiting Final Action 
04/01/2025
AMPICILLIN 500MG (VIAL)
04/01/2025
04/06/2025
IV
150mg
Q6hours
PCAP-C
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: