Mamentas, Jenalyn .

HRN: 05-57-15  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/08/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
04/08/2026
04/08/2026
IV
2g
PTOR
STAT PELVIC LAP
Checking Initial Appropriateness 
04/08/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
04/08/2026
04/08/2026
IV
2g
PTOR
STAT PELVIC LAP
Checking Initial Appropriateness 
04/09/2026
DOXYCYCLINE 100MG (CAP)
04/09/2026
04/15/2026
PO
100mg
Bid
S/p EL Ectopic
Checking Initial Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: