De Fiesta, Domingo A.

HRN: 28-71-05  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/18/2026
CEFTRIAXONE 1G (VIAL)
03/18/2026
03/25/2026
IV
1g
Q12
Pyelonephritis
Checking Initial Appropriateness 
03/18/2026
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
03/18/2026
03/25/2026
IV
2.25
Q6H
Empiric
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: