MonseÑeros, Rachem .

HRN: 23-73-68  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
08/20/2025
CEFUROXIME 750MG (VIAL)
08/20/2025
08/27/2025
IV
750mg
Q8
TC SEPSIS
Checking Initial Appropriateness 
08/23/2025
CEFTRIAXONE 1G (VIAL)
08/23/2025
08/30/2025
IV
2 Grams
Q 24
T/c Sepsis
Checking Initial Appropriateness 
08/25/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
08/25/2025
08/31/2025
IVT
240mg
Q12
Sepsis
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: