Sinoy, Ma. Shielafatima R.

HRN: 28-52-49  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
02/07/2026
CEFAZOLIN 1GM (VIAL)
02/07/2026
02/13/2026
IV
2 Grams
IV PTOR
Surgical Prophylaxis
Remove - Pending Acceptance
02/07/2026
CEFTRIAXONE 1G (VIAL)
02/07/2026
02/07/2026
2 GRAMS
IV
Ptor
Surgical Prophylaxis
Remove - Pending Acceptance
02/08/2026
DOXYCYCLINE 100MG (CAP)
02/08/2026
02/15/2026
PO
100
Bid
Ectopic Pregnancy
Checking Initial Appropriateness 
02/08/2026
METRONIDAZOLE 500MG (TAB)
02/08/2026
02/15/2026
PO
500
Tid
Ectopic Pregnancy. S/P Pelvic Lap
Checking Initial Appropriateness 
02/08/2026
METRONIDAZOLE 500MG (TAB)
02/08/2026
02/14/2026
ORAL
500mg
BID
S/P Pelvic Lap
Remove - Pending Acceptance

AMS Audit Form


Start Date: End Date:

Indication:

              

Type of Infection:

                             

           

Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: