Gabule, Baby Boy .

HRN: 29-00-78  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/17/2026
AMPICILLIN 500MG (VIAL)
05/17/2026
05/24/2026
IVT
165mg
Q12
T/C Neonatal Pneumonia
Checking Initial Appropriateness 
05/17/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
05/17/2026
05/23/2026
IVT
50mg
Q24
T/C Neonatal Pneumonia
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: