Mangogtong, Servilla N.

HRN: 06-38-26  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
07/17/2026
CIPROFLOXACIN 500MG (TAB)
07/17/2026
07/23/2026
PO
500mg
Q8
Complicated UTI
Checking Final Appropriateness 
07/17/2026
CIPROFLOXACIN 500MG (TAB)
07/17/2026
07/23/2026
ORAL
500mg
Tid
Complicated Uti
Checking Final 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: