Pacamaman, Baby Girl -.

HRN: 27-27-54  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/24/2025
AMPICILLIN 250MG (VIAL)
06/24/2025
07/01/2025
IV
130mg
Q12H
PSNB
Checking Initial Appropriateness 
06/24/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
06/24/2025
07/01/2025
IV
39mg
Q24H
PSNB
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: