Sy Egco, Jose .

HRN: 28-77-71  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/03/2026
CEFTRIAXONE 1G (VIAL)
04/03/2026
04/10/2026
IV
2g
Od
CAP-MR
Checking Initial Appropriateness 
04/03/2026
AZITHROMYCIN 500MG TABLET (TAB)
04/03/2026
04/07/2026
PO
500mg
Od
Capmr
Checking Initial Appropriateness 
04/07/2026
SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)
04/07/2026
04/13/2026
TOPICAL
Apply On Affected Areas
Bid
Skin And Soft Tissue Infection
Checking Initial Appropriateness 
05/03/2026
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
05/03/2026
05/03/2026
IV
4.5g
Now
Cap Hr
Checking Initial Appropriateness 
05/03/2026
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
05/03/2026
05/10/2026
IV
2.25g
Q8
CAP HR
Checking Initial Appropriateness 
05/06/2026
LEVOFLOXACIN 500MG (TAB)
05/06/2026
05/20/2026
PO
750mg
Q48h
CAP HR
Checking Initial Appropriateness 
05/06/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
05/06/2026
05/13/2026
IV
1100mg
Q24
PTB Bacteriologically Confirmed
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: