Catag, Alice B.

HRN: 29-29-82  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/14/2026
AMPICILLIN 500MG (VIAL)
07/14/2026
07/21/2026
IVT
135mg
Q12
T/C Meconium Aspiration Pneumonia
Checking Initial Appropriateness 
07/14/2026
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
07/14/2026
07/21/2026
IVT
41mg
Q24
T/C Meconium Aspiration Pneumonia
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: