Agalot, Jenie Rose .

HRN: 28-80-41  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/07/2026
AMPICILLIN 1GM (VIAL)
04/07/2026
04/08/2026
IVT
2g
Q6
Prom
Checking Initial Appropriateness 
04/07/2026
CEFUROXIME 500MG (TAB)
04/07/2026
04/13/2026
PO
500mg
Bid
Prom
Checking Initial Appropriateness 
04/07/2026
METRONIDAZOLE 500MG (TAB)
04/07/2026
04/13/2026
PO
500mg
Tid
Prom X19
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: