Salinas, Bb Boy .

HRN: 27-29-26  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/09/2025
AMPICILLIN 250MG (VIAL)
06/09/2025
06/16/2025
IV DRIP
135mg
Q12 Hours
PSNB (ER Delivery)
Checking Initial Appropriateness 
06/09/2025
GENTAMICIN 40MG/ML, 2ML (AMP)
06/09/2025
06/16/2025
IV DRIP
14mg
Q24hours
PSNB (ER Delivery)
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: