Jumawan, Baby Boy L.

HRN: 28-16-77  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/05/2025
AMPICILLIN 500MG (VIAL)
12/05/2025
12/12/2025
IVT
160mg
Q12
PSNB
Checking Initial Appropriateness 
12/05/2025
GENTAMICIN 40MG/ML, 2ML (AMP)
12/05/2025
12/12/2025
IVT
16mg
Q24
PSNB
Checking Initial Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: