Caburnay, Pabilta .

HRN: 28-96-51  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/07/2026
CEFTRIAXONE 1G (VIAL)
05/07/2026
05/14/2026
IV
2g
Od
CAP MR
Checking Initial Appropriateness 
05/07/2026
AZITHROMYCIN 500MG TABLET (TAB)
05/07/2026
05/11/2026
PO
50omg
Od
CAP-MR
Checking Initial Appropriateness 
05/11/2026
AZITHROMYCIN 500MG TABLET (TAB)
05/11/2026
05/14/2026
PO
500mgtab
Od
Cap Mr
Checking Initial Appropriateness 
05/11/2026
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
05/11/2026
05/17/2026
PO
1.5gm
Q6
CAP MR
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: