Flores, Jasper P.

HRN: 27-23-29  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
11/22/2025
AMPICILLIN 500MG (VIAL)
11/22/2025
11/29/2025
IV
300mg
Q6
PCAP
Checking Initial Appropriateness 
11/25/2025
AMOXICILLIN 250MG/5ML, 60ML SUSPENSION (BOT)
11/25/2025
11/30/2025
PO
1.6ml
TID
PCAP
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: