Angco, Baby Boy .

HRN: 29-12-23  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/05/2026
AMPICILLIN 500MG (VIAL)
06/05/2026
06/12/2026
IV
175mg
Q12H
T/C MAS
Checking Final Appropriateness 
06/05/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
06/05/2026
06/12/2026
IV
50mg
Q24H
T/C MAS
Checking Final 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: