Tabuan, Baby Boy .

HRN: 28-16-92  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/03/2025
AMPICILLIN 250MG (VIAL)
12/03/2025
12/10/2025
73MG
IVTT
Q12h
PSNB
Checking Final Appropriateness 
12/03/2025
GENTAMICIN 40MG/ML, 2ML (AMP)
12/03/2025
12/10/2025
IVTT
6mg
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: