Ayta, Danneza Mae P.

HRN: 27-64-59  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
08/18/2025
AMPICILLIN 1GM (VIAL)
08/18/2025
08/19/2025
IVTT
2g
Q6h
PROM
Checking Initial Appropriateness 
08/18/2025
CO-AMOXICLAV 625MG (TAB)
08/18/2025
08/25/2025
ORAL
625mg
BID
S/P NSD With Repair; PROM
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: