Yano, Juvie C.

HRN: 27-30-41  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
09/01/2025
AMPICILLIN 1GM (VIAL)
09/01/2025
09/08/2025
IVT
2GMS
Q6
PROM
Checking Initial Appropriateness 
09/01/2025
AMOXICILLIN 500MG CAPSULE (CAP)
09/01/2025
09/09/2025
PO
500mg
TID
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: