Francisco, Rezwen .

HRN: 26-60-07  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/07/2026
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
05/07/2026
05/14/2026
IV
330mg
Q6h
Acute Bacterial Infection; T/C Conjunctivitis
Checking Initial Appropriateness 
05/08/2026
CO-AMOXICLAV 457MG/5ML, 70ML SUSPENSION (BOT)
05/08/2026
05/15/2026
PO
2.2ml
BID
Acute Bacterial Infection; T/C Conjunctivitis
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: