Sistoso, Baby Boy .

HRN: 28-92-74  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/06/2026
AMPICILLIN 250MG (VIAL)
05/06/2026
05/13/2026
SIVP
210mg
Q12h
PSNB
Checking Initial Appropriateness 
05/06/2026
GENTAMICIN 40MG/ML, 2ML (AMP)
05/06/2026
05/13/2026
SIVP
21mg
Q24h
PSNB
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: