Lisondra, Clara E.

HRN: 28-99-30  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/12/2026
CEFTRIAXONE 1G (VIAL)
05/12/2026
05/19/2026
IV
2g
Od
Uti
Checking Initial Appropriateness 
05/12/2026
METRONIDAZOLE 5MG/ML, 100ML (VIAL)
05/12/2026
05/19/2026
IV
500mg
Q8
Amoebiasis Intestinal
Checking Initial Appropriateness 
05/12/2026
AZITHROMYCIN 500MG TABLET (TAB)
05/12/2026
05/16/2026
PO
500mg
Od
Cap Lr
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: