Pagayon, Evelyn P.

HRN: 28-05-95  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/02/2026
CEFTRIAXONE 1G (VIAL)
04/02/2026
04/09/2026
IV
2g
OD
UTI
Checking Initial Appropriateness 
04/06/2026
AZITHROMYCIN 500MG TABLET (TAB)
04/06/2026
04/11/2026
PO
500mg
OD
CAP-MR
Checking Initial Appropriateness 
04/07/2026
AZITHROMYCIN 500MG TABLET (TAB)
04/07/2026
04/09/2026
ORAL
500mg
OD
CAP
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: