Dela Peña, Elsie .

HRN: 08-20-66  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/05/2025
CEFTRIAXONE 1G (VIAL)
06/05/2025
06/12/2025
IV
2g
OD
CAP
Checking Initial Appropriateness 
06/05/2025
AZITHROMYCIN 500MG TABLET (TAB)
06/05/2025
06/10/2025
PO
1 Tab
OD
CAP
Checking Initial Appropriateness 
06/11/2025
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
06/11/2025
06/17/2025
IVT
4.5g
Q8
CAP HR
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: