Jore, Placido Q.

HRN: 26-35-65  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
11/17/2025
CEFTRIAXONE 1G (VIAL)
11/17/2025
11/24/2025
IVTT
2g
OD
CAPMR
Waiting Final Action 
11/17/2025
AZITHROMYCIN 500MG TABLET (TAB)
11/17/2025
11/22/2025
PO
500ng
OD
CAPMR
Waiting Final Action 
11/23/2025
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
11/23/2025
11/30/2025
IV
4.5g
Q6hr
CAP-HR
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: