Curbo, Baby Boy .

HRN: 28-66-30  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/06/2026
AMPICILLIN 1GM (VIAL)
03/06/2026
03/13/2026
IV
175mg
Q12h
PSNB
Checking Initial Appropriateness 
03/06/2026
GENTAMICIN 40MG/ML, 2ML (AMP)
03/06/2026
03/13/2026
IV
17mg
Q24h
PSNB
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: