Delos Santos, Daniella S.

HRN: 26-36-21  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/13/2026
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
01/13/2026
01/20/2026
IVTT
300 Mg
Q6hrs
PCAP C
Checking Initial Appropriateness 
01/13/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
01/13/2026
01/20/2026
IVTT
120 Mg
Q24HRS
PCAP C
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: