Supelanas, Merry Jean .

HRN: 28-87-40  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/07/2026
AMPICILLIN 1GM (VIAL)
06/07/2026
06/14/2026
IV
2g
Q6h
PROM
Checking Initial Appropriateness 
06/07/2026
METRONIDAZOLE 5MG/ML, 100ML (VIAL)
06/07/2026
06/08/2026
IV
500
Q8 X 3 Doses
Sp Ltcs
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: