Dalida, Hazel .

HRN: 24-64-52  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
09/10/2025
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
09/10/2025
09/17/2025
IV
100mg
Q6
Pcap C
Checking Initial Appropriateness 
09/11/2025
MUPIROCIN 2%, 15G (TUBE)
09/11/2025
09/17/2025
TOPICAL
Apply Thinly
BID
Cellulitis
Checking Initial Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: