Berallo, Jacklyn R.

HRN: 19-94-13  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
09/09/2022
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
09/09/2022
09/16/2022
IV
230mg
Q6h
Urti
Waiting Final Action 
09/12/2022
CEFTRIAXONE 1G (VIAL)
09/12/2022
09/19/2022
IV
455mg
Q12
Uti
Waiting Final Action 
09/14/2022
AZITHROMYCIN 200MG/5ML, 15ML SUSPENSION (SUSP)
09/14/2022
09/21/2022
PO
2.3ml On Day 1, Then 1ml Day2-5
OD
Pcap B
Waiting Final Action 

AMS Audit Form


Start Date: End Date:

 Indication:

              

 Type of Infection:

                             

           

 Compliance to guidelines:



 Initial appropriateness:



 If inappropriate:

           

 Final appropriateness:



 If inappropriate:

              

 Overall appropriateness: