Tinambing, Jessa .

HRN: 29-08-51  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/01/2026
AMPICILLIN 1GM (VIAL)
06/01/2026
06/08/2026
IV
2g
Q6
PROM
Checking Initial Appropriateness 
06/02/2026
CEFAZOLIN 1GM (VIAL)
06/02/2026
06/02/2026
IVT
2g
SD
CS
Checking Initial Appropriateness 
06/02/2026
CEFAZOLIN 1GM (VIAL)
06/02/2026
06/05/2026
IV
1 Gram
Q8h
CS
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: