Tilawan, Krizthian Jhie C.

HRN: 28-80-95  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/11/2026
CEFTRIAXONE 1G (VIAL)
04/11/2026
04/17/2026
IVT
2g
OD
UTI
Checking Initial Appropriateness 
04/11/2026
MEBENDAZOLE 100MG/5ML, 60ML SUSPENSION
04/11/2026
04/14/2026
ORAL
5ml
BID
Intestinal Parasitism
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: