Sante, Ruby Faith Y.

HRN: 28-32-75  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/15/2026
CEFTRIAXONE 1G (VIAL)
01/15/2026
01/22/2026
IV
550mg
Q12
Pcap
Checking Initial Appropriateness 
01/17/2026
AZITHROMYCIN 200MG/5ML, 15ML SUSPENSION (SUSP)
01/17/2026
01/21/2026
PO
2.75ml
OD
PCAP
Checking Initial Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



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Overall appropriateness: