Bite, Marife C.

HRN: 28-75-72  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
03/28/2026
CEFTRIAXONE 1G (VIAL)
03/28/2026
03/28/2026
IVTT
2g
PTOR
Ruptured Ectopic Pregnancy
Checking Initial Appropriateness 
03/28/2026
DOXYCYCLINE 100MG (CAP)
03/28/2026
04/04/2026
PO
1 Tab
BID
S/P Pelvic Lap Ruptured Ectopic Pregnancy
Checking Initial Appropriateness 
03/29/2026
MEBENDAZOLE 500MG (TAB)
03/29/2026
04/04/2026
ORAL
500mg
TID
Sp Pelvic Lap
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: