Palma, Shirlito V.

HRN: 27-82-40  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
09/22/2025
AZITHROMYCIN 500MG TABLET (TAB)
09/22/2025
09/26/2025
PO
500 Mg
Bid
Urti
Rejected 
09/22/2025
AZITHROMYCIN 500MG TABLET (TAB)
09/22/2025
09/26/2025
PO
500 Mg
Od
Urti
Waiting Final Action 
09/23/2025
CEFTRIAXONE 1G (VIAL)
09/23/2025
09/30/2025
IVTT
Q24H
OD
CAP
Checking Initial Appropriateness 
09/23/2025
CIPROFLOXACIN 500MG (TAB)
09/23/2025
09/30/2025
PO
500mg
BID
Infectious Diarrhea
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: