Sumalpong, Rr June S.

HRN: 13-11-51  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/10/2026
CEFTRIAXONE 1G (VIAL)
03/10/2026
03/17/2026
IV
1g
Q12
Fracture, Close, Complete Mid To Distal Third Of Radius, Left
Remove - Pending Acceptance
03/10/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
03/11/2026
03/11/2026
IV
1g
Single Dose
Fracture, Close, Complete, Mid To Distal Third Of Radius, Left
Remove - Pending Acceptance

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: