Medina, Elsebeto V.

HRN: 29-17-67  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/20/2026
CEFTRIAXONE 1G (VIAL)
06/20/2026
06/26/2026
IV
2GM
OD
CAP MR
Checking Initial Appropriateness 
06/20/2026
AZITHROMYCIN 500MG TABLET (TAB)
06/20/2026
06/24/2026
ORAL
500MG
OD
CAP MR
Checking Initial Appropriateness 
06/22/2026
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
06/22/2026
06/22/2026
IV
4.5g IG
Loading Dose Now
CAP-MR, PTB
Checking Initial Appropriateness 
06/22/2026
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
06/22/2026
06/29/2026
IV
2.25g
Q6H
CAP-MR, PTB
Checking Initial Appropriateness 
06/26/2026
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
06/26/2026
07/03/2026
IVTT
4.5g
Q6H
CAP-HR
Checking Initial Appropriateness 
07/02/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
07/02/2026
07/08/2026
IV
600mg
Q24H
VAP On Top Of CAP
Checking Initial Appropriateness 
07/02/2026
LEVOFLOXACIN 5MG/ML, 100ML (VIAL)
07/02/2026
07/08/2026
IV
750mg
Q24H
VAP On Top Of CAP
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: