Gulbin, Jerian .

HRN: 28-60-17  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
02/18/2026
AMPICILLIN 500MG (VIAL)
02/18/2026
02/24/2026
IV
380mg
Q6
PCAP
Checking Initial Appropriateness 
02/20/2026
CLARITHROMYCIN 125MG/5ML, 60ML SUSPENSION (BOT)
02/20/2026
02/27/2026
PO
4.5 Ml
Q 12
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: