Agalot, Baby Boy .

HRN: 28-79-69  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/07/2026
AMPICILLIN 250MG (VIAL)
04/07/2026
04/13/2026
IV
125mg
Q12
PROM
Remove - Pending Acceptance
04/07/2026
GENTAMICIN 40MG/ML, 2ML (AMP)
04/07/2026
04/13/2026
IV
12.5mg
Q24
PROM
Remove - Pending Acceptance
04/11/2026
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
04/11/2026
04/17/2026
IV
250mg
Q12H
Neonatal Sepsis (E. Coli)
Remove - Pending Acceptance

AMS Audit Form


Start Date: End Date:

Indication:

              

Type of Infection:

                             

           

Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: