Ito, Ramon D.

HRN: 29-27-91  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/09/2026
CEFTRIAXONE 1G (VIAL)
07/09/2026
07/15/2026
IV
2g
OD
Cap Hr
Checking Initial Appropriateness 
07/09/2026
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
07/09/2026
07/15/2026
IV
4.5gm
Q8
CAP HR
Checking Initial Appropriateness 
07/09/2026
CLINDAMYCIN 150MG/ML, 4ML (AMP)
07/09/2026
07/15/2026
IV
300mg
Q6
Sacral Ulcer
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: