Banasco, Gloria N.

HRN: 24-12-93  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/15/2025
CEFTRIAXONE 1G (VIAL)
12/15/2025
12/22/2025
IV
2gms
OD
CAP MR
Checking Final Appropriateness 
12/15/2025
AZITHROMYCIN 500MG TABLET (TAB)
12/15/2025
12/20/2025
PO
500mg/tab
OD
CAP MR
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: