Mayo, Wilson M.

HRN: 18-26-15  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
08/14/2025
CEFTRIAXONE 1G (VIAL)
08/14/2025
08/21/2025
IV
2G
OD
CAP-MR
Checking Initial Appropriateness 
08/14/2025
AZITHROMYCIN 500MG TABLET (TAB)
08/14/2025
08/19/2025
PO
500 Mg/tab
OD
CAP-MR
Checking Initial Appropriateness 
08/14/2025
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
08/14/2025
08/20/2025
IV
4.5
Q8
CAP HR
Checking Initial Appropriateness 
08/17/2025
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
08/17/2025
08/31/2025
IV
4.5g
Q6
CAPHR
Checking Initial Appropriateness 
08/25/2025
AMOXICILLIN 500MG CAPSULE (CAP)
08/25/2025
09/08/2025
PO
1g
Q12
H. Pylori
Checking Initial Appropriateness 
08/25/2025
CLARITHROMYCIN 500MG (CAP)
08/25/2025
09/08/2025
PO
500
Q12
H. Pylori
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: