Banagan, Merlita G.

HRN: 25-80-97  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
08/01/2025
CEFTRIAXONE 1G (VIAL)
08/01/2025
08/07/2025
IV
2 Grams
OD
Uti
Checking Initial Appropriateness 
08/04/2025
CLARITHROMYCIN 500MG (CAP)
08/04/2025
08/11/2025
PO
500 Mg
Q12 Hrs
UTI
Checking Initial Appropriateness 
08/08/2025
LEVOFLOXACIN 5MG/ML, 100ML (VIAL)
08/08/2025
08/15/2025
IV
500mg
OD
UTI
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: