Gomisong, Arlina T.

HRN: 17-23-90  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/07/2025
AZITHROMYCIN 500MG TABLET (TAB)
12/07/2025
12/11/2025
PO
500mg
OD
CAP MR
Checking Final Appropriateness 
12/07/2025
CEFTRIAXONE 1G (VIAL)
12/07/2025
12/13/2025
IV
2g
OD
CAP MR
Checking Final Appropriateness 
12/07/2025
SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)
12/07/2025
12/13/2025
TOPICAL
1%
BID
Gluteal Ulcer
Checking Final Appropriateness 
12/07/2025
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
12/07/2025
12/07/2025
IV
4.5g
LD
CAP MR, Gluteal Ulcer
Checking Final Appropriateness 
12/07/2025
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
12/07/2025
12/13/2025
IV
2.25g
Q6h
CAP MR, Gluteal Ulcer
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: