Vasay, Jessa Mae .

HRN: 22-20-51  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/03/2026
AMPICILLIN 1GM (VIAL)
01/03/2026
01/04/2026
IVT
2g
Q6
PROM
Checking Final Appropriateness 
01/03/2026
CEFUROXIME 500MG (TAB)
01/03/2026
01/10/2026
PO
500
Bid
Prom X 20 Hrs
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: