Demayo, Bb Boy I .

HRN: 28-31-57  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/27/2025
AMPICILLIN 250MG (VIAL)
12/27/2025
01/03/2026
IV
155mg
Q12
PSNB
Checking Initial Appropriateness 
12/27/2025
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
12/27/2025
01/03/2026
IV
40mg
Q24
PSNB
Checking Initial Appropriateness 
12/27/2025
GENTAMICIN 40MG/ML, 2ML (AMP)
12/27/2025
01/03/2026
IV
12mg
Q24
PSNB
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: