Jambaro, Rafael S.

HRN: 28-41-90  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
06/27/2026
CEFTRIAXONE 1G (VIAL)
06/27/2026
07/03/2026
IV
1g
Q12h
Uti
Checking Initial Appropriateness 
07/04/2026
CO-AMOXICLAV 625MG (TAB)
07/04/2026
07/11/2026
PO
625mg/tab
Q8
Cap
Checking Initial Appropriateness 
07/06/2026
AMOXICILLIN 500MG CAPSULE (CAP)
07/06/2026
07/13/2026
TAB
500
TID
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: