Buot, San Pablo V.

HRN: 29-08-19  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/30/2026
CEFTRIAXONE 1G (VIAL)
05/30/2026
06/05/2026
IV
2g
Od
Cap-mr
Checking Initial Appropriateness 
05/30/2026
AZITHROMYCIN 500MG TABLET (TAB)
05/30/2026
06/03/2026
PO
500mg
Od
Cap-mr
Checking Initial Appropriateness 
06/06/2026
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
06/06/2026
06/12/2026
IV
4.5gm
Q8
Cap Mr
Rejected 
06/11/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
06/11/2026
06/17/2026
IV
1200gms
OD
OD
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: