Ungab, Baby Girl .

HRN: 27-84-84  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
10/02/2025
AMPICILLIN 500MG (VIAL)
10/02/2025
10/09/2025
IVT
133mg
Q12
T/C MAS
Checking Initial Appropriateness 
10/02/2025
GENTAMICIN 40MG/ML, 2ML (AMP)
10/02/2025
10/08/2025
IVT
13mg
Q24
T/C MAS
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: