Balolong, Maria Sophia S.

HRN: 27-96-32  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
10/17/2025
SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)
10/17/2025
10/24/2025
TOPICAL
Apply Directly
Daily
Burn Injury
Waiting Final Action 
10/17/2025
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
10/17/2025
10/24/2025
IV
200mg
Q 6H
Partial Thickness Burns, Face, Left Side Of Torso, Thigh
Waiting Final Action 
10/18/2025
SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)
10/18/2025
11/01/2025
TOPICAL
Apply Directly
Daily
S/P Debridement
Waiting Final Action 
10/25/2025
SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)
10/25/2025
11/01/2025
TOPICAL
Apply Thinly To Burn Areas
Every 12hrs (BID)
Empiric
Checking Final Appropriateness 

AMS Audit Form


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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



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Overall appropriateness: