Mission, Tresha Faith S.

HRN: 28-02-67  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/23/2026
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
06/23/2026
06/30/2026
IV
400MG
Q6H
PCAP C
Checking Initial Appropriateness 
06/26/2026
PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)
06/26/2026
07/06/2026
IV
770mg
Q8
PCAP; Sepsis
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: