Gevarra, Jaycob B.

HRN: 23-72-50  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/02/2025
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
06/02/2025
06/09/2025
IV
250mg
Q6hours
Aspiration Pneumonia
Waiting Final Action 
06/09/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
05/28/2025
06/11/2025
IV
30mg
Q12hours
Aspiration Pneumonia
Remove - Pending Acceptance
06/12/2025
MUPIROCIN 2%, 15G (TUBE)
06/12/2025
06/18/2025
TOPICALLY
15g
BID
Skin Lesion
Checking Initial Appropriateness 
06/12/2025
FLUCONAZOLE 50MG (CAP)
06/12/2025
06/18/2025
ORAL
25mg
2x/week
T/c Fungal Infection
Checking Initial Appropriateness 
06/12/2025
SODIUM FUSIDATE 20MG/G, 15G OINTMENT
06/12/2025
06/18/2025
TOPICAL
20mg
BID
Skin Lesion
Checking Initial Appropriateness 
06/16/2025
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
06/16/2025
06/23/2025
IV
250mg
Q6H
PCAP C
Checking Initial Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

Type of Infection:

                             

           

Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: