Balsano, Baby Girl .

HRN: 27-66-63  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
08/22/2025
AMPICILLIN 250MG (VIAL)
08/22/2025
08/28/2025
IVT
130mg
Q12
Prophylaxis
Checking Initial Appropriateness 
08/22/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
08/22/2025
08/28/2025
IVT
39mg
Q24
Prophylaxis
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: