Dique, Carmelita R.

HRN: 07-62-42  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
11/02/2025
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
11/02/2025
12/03/2025
IV DRIP
2.25g
Q6
CAP-HR
Waiting Final Action 
01/10/2026
MUPIROCIN 2%, 15G (TUBE)
01/10/2026
01/17/2026
TOPICAL
Apply Thinly
BID
S/P Tracheostomy
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: