Gaban, Edwin R.

HRN: 29-47-23  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
08/10/2026
CEFTRIAXONE 1G (VIAL)
08/10/2026
08/16/2026
IV
2g
Q12h
Acute Bacterial Meningitis
Checking Initial Appropriateness 
08/11/2026
ACICLOVIR 250MG VIAL (I.V. INFUSION)
08/11/2026
08/18/2026
IV
500
Q8
Encephalotis
Checking Initial Appropriateness 

AMS Audit Form


Start Date: End Date:

Indication:

              

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Compliance to guidelines:



Initial appropriateness:



 If inappropriate:

           

Final appropriateness:



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Overall appropriateness: