Tacloban, Bb Girl .

HRN: 28-02-57  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
11/04/2025
AMPICILLIN 250MG (VIAL)
11/04/2025
11/11/2025
IVTT
150mg
Q12hrs
PSNB
Checking Final Appropriateness 
11/04/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
11/04/2025
11/11/2025
IVTT
45mg
Q24h
PSNB
Checking Final 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: