Alejandrino, Crispulo F.

HRN: 20-80-29  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/06/2026
CEFTRIAXONE 1G (VIAL)
05/06/2026
05/12/2026
IV
2g
OD
Non-healing Wound
Checking Initial Appropriateness 
05/06/2026
CLINDAMYCIN 150MG/ML, 4ML (AMP)
05/06/2026
05/12/2026
IV
600mg
Q6
Nonhealing Wound
Checking Initial Appropriateness 
05/06/2026
MUPIROCIN 2%, 15G (TUBE)
05/06/2026
05/12/2026
TOPICAL
15g
BID
Nonhealing Wound
Checking Initial Appropriateness 
05/06/2026
AZITHROMYCIN 500MG TABLET (TAB)
05/06/2026
05/10/2026
ORAL
500mg
OD
CAP-MR
Checking Initial Appropriateness 
05/07/2026
SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)
05/07/2026
05/13/2026
TOPICAL
Topical
BID
Infected Wound
Checking Initial Appropriateness 
05/08/2026
CLINDAMYCIN 300MG (CAP)
05/08/2026
05/14/2026
PO
300mgcap
QID
Infected Wound
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: