Lipae, Lucky L.

HRN: 28-73-07  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/27/2026
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
05/27/2026
06/03/2026
IV
200mg
Q6
PCAP
Checking Initial Appropriateness 
05/28/2026
CEFTRIAXONE 1G (VIAL)
05/28/2026
06/04/2026
IV
210MG
Q12H
PCAP C
Checking Initial Appropriateness 
05/28/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
05/28/2026
06/03/2026
IV
62mg
Q24
PCAPC
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: