Barrios, Juanita M.

HRN: 27-64-76  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/26/2025
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
12/26/2025
01/02/2026
IVT
1.5g
Q8
Non Healing Wound Left
Checking Initial Appropriateness 
12/26/2025
CLINDAMYCIN 150MG/ML, 4ML (AMP)
12/26/2025
01/02/2026
IVT
600mg
Q8
Nonhealing Wound Left
Checking Initial Appropriateness 
01/03/2026
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
01/03/2026
01/03/2026
IVT
4.5g
Ld
Non Healing Wound
Checking Final Appropriateness 
01/03/2026
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
01/03/2026
01/10/2026
IVT
2.25g
Q6
Non Healing 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: