Dalion, Cherlyn Joy M.

HRN: 27-99-09  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/24/2026
AMPICILLIN 1GM (VIAL)
01/24/2026
01/25/2026
IV
2gms
Q6hrs
PROM
Checking Initial Appropriateness 
01/27/2026
CEFTRIAXONE 1G (VIAL)
01/27/2026
01/29/2026
IVTT
2g
OD
UTI
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: