Garciano, Stefi Neri J.

HRN: 22-05-63  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
10/06/2022
AMPICILLIN 500MG (VIAL)
10/06/2022
10/12/2022
IVT
200mg
Q6hrs
Pcap C
Waiting Final Action 
10/08/2022
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
10/08/2022
10/14/2022
IV
120mg
Q24hrs
Pcap C; UTI
Waiting Final Action 
10/08/2022
AMIKACIN 250MG/ML, 2ML (VIAL/AMP)
10/08/2022
10/14/2022
IV
120mg
Q24hrs
Pcap C; UTI
Waiting Final Action 

AMS Audit Form


Start Date: End Date:

 Indication:

              

 Type of Infection:

                             

           

 Compliance to guidelines:



 Initial appropriateness:



 If inappropriate:

           

 Final appropriateness:



 If inappropriate:

              

 Overall appropriateness: