Balase, Baby Girl .

HRN: 26-97-17  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/24/2025
AMPICILLIN 250MG (VIAL)
04/24/2025
04/30/2025
IVTT
200mg
Q12H
MSAF
Waiting Final Action 
04/24/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
04/24/2025
04/30/2025
IVTT
50 MG
Q24h
MSAF
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: