Gallo, Baby Boy -.

HRN: 27-51-54  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/25/2025
AMPICILLIN 250MG (VIAL)
07/25/2025
08/01/2025
IV
160mg
Q12H
PROM X 20hours
Remove - Pending Acceptance
07/25/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
07/25/2025
08/01/2025
IV
48mg
Q24H
PROM X 20hours
Remove - Pending Acceptance

AMS Audit Form


Start Date: End Date:

Indication:

              

Type of Infection:

                             

           

Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: