Deldacan, Jana Mae A.

HRN: 29-02-76  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/21/2026
CEFTRIAXONE 1G (VIAL)
05/21/2026
05/28/2026
IV
2g
OD
CAPMR
Checking Initial Appropriateness 
05/21/2026
AZITHROMYCIN 500MG TABLET (TAB)
05/21/2026
05/28/2026
PO
500mg
OD
CAPMR
Checking Initial Appropriateness 
05/28/2026
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
05/28/2026
06/04/2026
IVT
1.5g
Q6
Acinetobacter Iwoffii/haemolyticus
Checking Initial Appropriateness 
06/02/2026
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
06/02/2026
06/08/2026
IV
9gm
Q6
CAP MR Acinetobacter
Checking Initial Appropriateness 
06/12/2026
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
06/12/2026
06/18/2026
IV
9gms
Q6h
CAP MR Acinetobacter
Checking Initial Appropriateness 

AMS Audit Form


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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



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Overall appropriateness: