Manapad, Baby Girl .

HRN: 28-44-76  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/30/2026
AMPICILLIN 250MG (VIAL)
01/30/2026
02/06/2026
IV
105mg
Q12
Acute Bacterial Infection, Unspecified
Checking Initial Appropriateness 
01/30/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
01/30/2026
02/06/2026
IV
32mg
Q24
Acute Bacterial Infection, Unspecified
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: