Custodio, Ma. Teresa R.

HRN: 25 21 69  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/18/2025
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
12/18/2025
12/24/2025
IV INFUSION
1.5gm
Q6
Infected Wound
Checking Final Appropriateness 
12/18/2025
CLINDAMYCIN 150MG/ML, 4ML (AMP)
12/18/2025
12/24/2025
IV
600mg
Q8
Infected Wound
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: