Jordan, Baby Girl .

HRN: 29-12-18  Sex: Female

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
165mg
Q12H
NAMF (Thickly MSAF)
Checking Final Appropriateness 
06/05/2026
FLUCONAZOLE 150MG (CAP)
06/05/2026
06/12/2026
IV
16.5mg
Q24h
NAMF (Thickly MSAF)
Checking Final Appropriateness 
06/05/2026
GENTAMICIN 40MG/ML, 2ML (AMP)
06/05/2026
06/12/2026
IVTT
16.5mg
Q24h
NAMF (thickly MSAF)
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: