Manisan, Baby Girl .

HRN: 29-25-69  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/09/2026
AMPICILLIN 250MG (VIAL)
07/09/2026
07/16/2026
IV
130mg
Q12h
PSNB
Checking Initial Appropriateness 
07/09/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
07/09/2026
07/16/2026
IV
39mg
Q24h
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: