Villarta, Genelyn .

HRN: 28-25-07  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/29/2025
AMPICILLIN 1GM (VIAL)
12/29/2025
01/05/2026
IV
2g
Q6h
PROM
Checking Initial Appropriateness 
12/30/2025
CEFUROXIME 500MG (TAB)
12/30/2025
01/06/2026
PO
500
Bid
Uti
Checking Final Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: