Pagalaran, Rosemy J.

HRN: 28-88-60  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/20/2026
CEFTRIAXONE 1G (VIAL)
04/20/2026
04/27/2026
IV
2g
OD
CAP MR
Checking Initial Appropriateness 
04/20/2026
AZITHROMYCIN 500MG TABLET (TAB)
04/20/2026
04/25/2026
PO
500
OD
CAP MR
Checking Initial Appropriateness 
04/25/2026
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
04/25/2026
05/02/2026
IVTT
4.5g
Q8H
CAP-HR
Checking Initial Appropriateness 
04/30/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
04/30/2026
05/07/2026
IV
900
OD
CAP HR
Checking Initial Appropriateness 
05/13/2026
LEVOFLOXACIN 5MG/ML, 100ML (VIAL)
05/13/2026
05/19/2026
IV
750mg
Q24
Cap HR
Checking Initial Appropriateness 
05/13/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
05/13/2026
05/19/2026
IV
900mg
Q24
CAP HR
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: