Diplon, Baby Boy .

HRN: 29-25-33  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/03/2026
AMPICILLIN 250MG (VIAL)
07/03/2026
07/10/2026
IV
160mg
Q12h
T/C NEONATAL SEPSIS
Remove - Pending Acceptance
07/03/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
07/03/2026
07/10/2026
IV
48mg
Q24h
T/C NEONATAL SEPSIS
Remove - Pending Acceptance

AMS Audit Form


Start Date: End Date:

Indication:

              

Type of Infection:

                             

           

Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: