Diwa, Khalif M.

HRN: 27-84-75  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
12/30/2025
CEFTRIAXONE 1G (VIAL)
12/30/2025
12/30/2025
IV DRIP
300mg
Q12
PCAP-C With Moderate Dehydration
Checking Initial Appropriateness 
12/30/2025
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
12/30/2025
01/06/2026
IV DRIP
480mg
Q8
PCAP-C With Moderate Dehydration
Checking Initial Appropriateness 
01/01/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
01/01/2026
01/08/2026
IV
90 Mg
Q24hrs
Pcap C
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: