Tagalog, Baby Boy .

HRN: 27-84-39  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
09/25/2025
AMPICILLIN 250MG (VIAL)
09/25/2025
10/02/2025
IV
180mg
Q12
PSNB
Checking Initial Appropriateness 
09/25/2025
GENTAMICIN 40MG/ML, 2ML (AMP)
09/25/2025
10/02/2025
IV
18mg
Q24
PSNB
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: