Ventura, Danward .

HRN: 28-80-15  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/06/2026
CEFTRIAXONE 1G (VIAL)
04/06/2026
04/13/2026
IV
2g
Od
Cap Mr
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
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
04/07/2026
04/13/2026
IV
4.50mg Now, Then 2.25mg Q8h
Q8h
CAP HR
Checking Initial Appropriateness 
04/21/2026
CIPROFLOXACIN 500MG (TAB)
04/21/2026
04/27/2026
PO
1/2 Tab
Bid
Cap MR
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: