Sanchez, Manilyn C.

HRN: 27-79-83  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
09/12/2025
CEFTRIAXONE 1G (VIAL)
09/12/2025
09/19/2025
IV
2g
OD
CAP HR
Checking Initial Appropriateness 
09/12/2025
AZITHROMYCIN 500MG TABLET (TAB)
09/12/2025
09/19/2025
IV
500mg
OD
CAP HR
Checking Initial Appropriateness 
09/12/2025
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
09/12/2025
10/02/2025
IV
4.5
Q8
SEPSIS CAP MR
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: