Balambao, Maylene .

HRN: 28-77-95  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/03/2026
AMPICILLIN 1GM (VIAL)
05/03/2026
05/10/2026
IV
2 Grams
Q6
Prom
Checking Initial Appropriateness 
05/04/2026
METRONIDAZOLE 125MG/5ML, 60ML (BOT)
05/04/2026
05/06/2026
IV
500mg
Q8h
S/P CS
Checking Initial Appropriateness 
05/04/2026
METRONIDAZOLE 500MG (TAB)
05/04/2026
05/11/2026
PO
1 Tab
TID
S/P CS
Checking Initial Appropriateness 
05/04/2026
CEFAZOLIN 1GM (VIAL)
05/04/2026
05/04/2026
IV
1 Gram
PTOR
For STAT CS
Checking Initial Appropriateness 
05/04/2026
METRONIDAZOLE 5MG/ML, 100ML (VIAL)
05/04/2026
05/05/2026
IV
500mg
Q8h
S/P CS
Checking Initial Appropriateness 
05/05/2026
MUPIROCIN 2%, 15G (TUBE)
05/05/2026
05/12/2026
TOPICAL
Pea Sized
BID
S/P CS
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: