Montebon, Paterno F.

HRN: 28-26-97  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/16/2025
CEFTRIAXONE 1G (VIAL)
12/16/2025
12/22/2025
IV
2 Grams
OD
Uti
Checking Final Appropriateness 
12/21/2025
LEVOFLOXACIN 500MG (TAB)
12/21/2025
12/27/2025
PO
750 Mg
OD
Uti
Checking Final Appropriateness 
12/21/2025
LEVOFLOXACIN 500MG (TAB)
12/21/2025
12/28/2025
PO
500mg
OD
UTI
Checking Final Appropriateness 
12/23/2025
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
12/23/2025
12/30/2025
IV
4.5
Q6H
Complicated UTI
Checking Initial 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: