Laylay, Wilfredo D.

HRN: 16-14-51  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/02/2026
RIFAXIMIN 200MG (TAB)
03/02/2026
03/06/2026
PO
200
2 Tabs TID
Bacterial Peritonitis
Checking Initial Appropriateness 
03/02/2026
CIPROFLOXACIN 500MG (TAB)
03/02/2026
03/13/2026
PO
500 Mg
Bid
Peritonitis
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: