Azucena, Rosemarie D.

HRN: 18-15-09  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/10/2026
CEFTRIAXONE 1G (VIAL)
05/10/2026
05/17/2026
IV
2g
Od
Uti
Checking Initial Appropriateness 
05/11/2026
AMOXICILLIN 500MG CAPSULE (CAP)
05/11/2026
05/17/2026
ORAL
1g
BID
H.pylori (PUD)
Checking Initial Appropriateness 
05/11/2026
CLARITHROMYCIN 500MG (CAP)
05/11/2026
05/17/2026
ORAL
500mg
BID
PUD (h.pylori)
Checking Initial Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



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Overall appropriateness: