Basilan, Baby Boy .

HRN: 28-24-16  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/09/2025
AMPICILLIN 500MG (VIAL)
12/09/2025
12/16/2025
IV
150mg
Q12
PSNB (PROM X 1 Day)
Checking Final Appropriateness 
12/09/2025
GENTAMICIN 40MG/ML, 2ML (AMP)
12/09/2025
12/15/2025
IVT
15mg
Q24
PSNB (PROM X 1 Day)
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: