Dugaduga, Bb Girl .

HRN: 28-69-71  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/16/2026
AMPICILLIN 250MG (VIAL)
03/16/2026
03/22/2026
IV
150mg
Q12
PROM X 24 Hours
Checking Initial Appropriateness 
03/16/2026
GENTAMICIN 40MG/ML, 2ML (AMP)
03/16/2026
03/22/2026
IV
15mg
Q24
PROM X 24 Hours
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: