TaÑeza, Aspen Hezekiah A.

HRN: 26-52-12  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/15/2026
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
01/15/2026
01/22/2026
IV
460mg
Q6h
PCAP-C
Checking Initial Appropriateness 
01/15/2026
CEFTRIAXONE 1G (VIAL)
01/15/2026
01/22/2026
IV
460mg
Q12
PCAP
Checking Initial Appropriateness 
01/18/2026
AZITHROMYCIN 200MG/5ML, 15ML SUSPENSION (SUSP)
01/18/2026
01/21/2026
PO
2.3ml
Od
PCAP
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: