Carillo, Teresita M.

HRN: 12-54-28  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/13/2026
CEFTRIAXONE 1G (VIAL)
05/13/2026
05/20/2026
IV
2g
OD
Cholecystitis
Checking Initial Appropriateness 
05/16/2026
LEVOFLOXACIN 500MG (TAB)
05/16/2026
06/14/2026
PO
750mg
OD
PTB
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: