Elarcosa, Jesrylle Jhay S.

HRN: 27-43-62  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/14/2025
AMPICILLIN 500MG (VIAL)
07/14/2025
07/20/2025
IVT
145mg
Q12
Omphalitis
Checking Initial Appropriateness 
07/14/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
07/14/2025
07/20/2025
IVT
15mg
Q24
Omphalitis
Checking Initial Appropriateness 
07/15/2025
MUPIROCIN 2%, 15G (TUBE)
07/15/2025
07/22/2025
TOPICAL
2%
OD
Omphalitis
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: