Tarnate, Bb Boy .

HRN: 28-09-91  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
11/24/2025
AMPICILLIN 250MG (VIAL)
11/24/2025
12/01/2025
IV
135mg
Q12
T/C MAS
Checking Initial Appropriateness 
11/24/2025
GENTAMICIN 40MG/ML, 2ML (AMP)
11/24/2025
12/01/2025
IV
10.8mg
Q24
T/C MAS
Checking Initial Appropriateness 

AMS Audit Form


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Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: