Libet, Bb Girl .

HRN: 28-31-66  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/29/2025
AMPICILLIN 250MG (VIAL)
12/29/2025
01/05/2026
IV
130 Mg
Q12hrs
Sepsis Neonatorum
Checking Initial Appropriateness 
12/29/2025
GENTAMICIN 40MG/ML, 2ML (AMP)
12/29/2025
01/05/2026
IV
13 Mg
Q24hrs
Sepsis Neonatorum
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: