Tilus, Riezza Ann H.

HRN: 26-85-06  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
02/03/2026
CO-AMOXICLAV 625MG (TAB)
02/03/2026
02/10/2026
PO
625 MG/TAB
TID
CAP LR
Checking Initial Appropriateness 
02/03/2026
AZITHROMYCIN 500MG TABLET (TAB)
02/03/2026
02/07/2026
PO
500mg
OD
CAP LR
Checking Initial Appropriateness 
02/04/2026
CEFTRIAXONE 1G (VIAL)
02/04/2026
02/10/2026
IV
2g
OD
UTI
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: