Dela Cruz, Bb Girl .

HRN: 29-25-74  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/08/2026
AMPICILLIN 250MG (VIAL)
07/08/2026
07/14/2026
IV
150mg
Q12
PSNB
Checking Initial Appropriateness 
07/08/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
07/08/2026
07/14/2026
IV
45mg
Q24
PSNB
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: