Tumutod, Baby Boy .

HRN: 25-65-90  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
02/03/2026
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
02/03/2026
02/10/2026
IV DRIP
400mg
Q6
PCAP-C
Checking Initial Appropriateness 
02/04/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
02/04/2026
02/10/2026
IVT
50mg
Q8
PCAP-C
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: