Alferez, Baby Boy .

HRN: 28-73-43  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/24/2026
AMPICILLIN 250MG (VIAL)
03/24/2026
03/31/2026
IV
210mg
Q12
Sepsis
Checking Initial Appropriateness 
03/24/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
03/24/2026
03/31/2026
IV
50mg
Q24
Sepsis
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: