Felicio, Baby Boy B.

HRN: 29-06-63  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/27/2026
AMPICILLIN 250MG (VIAL)
05/27/2026
06/03/2026
IV
165MG
Q12
PSNB
Checking Initial Appropriateness 
05/27/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
05/27/2026
06/03/2026
IV
39MG
Q24
PSNB
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: