Hidalgo, Baby Boy .

HRN: 29-12-59  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/08/2026
AMPICILLIN 500MG (VIAL)
06/08/2026
06/15/2026
IVT
120mg
Q12
PSNB (PROM X 20HRS)
Checking Initial Appropriateness 
06/08/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
06/08/2026
06/14/2026
IVT
36mg
Q24
PSNB (PROM X 20HRS)
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: