Balsamo, Jovina P.

HRN: 28-90-93  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/06/2026
AMPICILLIN 1GM (VIAL)
05/06/2026
05/08/2026
IVT
2GMS
Q6
PROMX11 HRS
Checking Initial Appropriateness 
05/08/2026
CO-AMOXICLAV 625MG (TAB)
05/08/2026
05/15/2026
PO
625 Mg/tab
BID
S/P CS
Checking Initial Appropriateness 

AMS Audit Form


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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



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Overall appropriateness: