Dela Peña, Leodelin B.

HRN: 28-63-11  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
02/25/2026
AMPICILLIN 1GM (VIAL)
02/25/2026
02/26/2026
IVTT
2g
Q6h
PROM
Checking Initial Appropriateness 
02/25/2026
CEFAZOLIN 1GM (VIAL)
02/25/2026
02/25/2026
IVTT
2g
PTOR
For STAT CS
Checking Initial Appropriateness 
02/25/2026
CEFAZOLIN 1GM (VIAL)
02/25/2026
02/26/2026
IV
1 G X 3 Doses
Q8
Sp 1 LTCS
Checking Initial Appropriateness 
02/25/2026
MUPIROCIN 2%, 15G (TUBE)
02/25/2026
03/03/2026
SKIN
2%
OD
Sp 1 LTCS
Checking Initial Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: