Boac, Emelia D.

HRN: 28-70-16  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
08/10/2026
PIPERACILLIN + TAZOBACTAM 4.5G (VLS)
08/10/2026
08/16/2026
IVTT
4.5g
Q6h
Cap HR
Checking Initial Appropriateness 
08/10/2026
AZITHROMYCIN 500MG TABLET (TAB)
08/10/2026
08/14/2026
ORAL
500 Mg/tab, 1 Tab
OD
Cap HR
Checking Initial Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



 If inappropriate:

              

Overall appropriateness: