Maato, Provincio L.

HRN: 05-52-21  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
05/08/2022
ACICLOVIR 800MG (TAB)
05/08/2022
05/15/2022
PO
800mg
5x A Day
Shingles
Waiting Final Action 
05/08/2022
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
05/08/2022
05/15/2022
IV
1.5gm
Q12
Soft Tissue Infection
Waiting Final Action 
05/08/2022
MUPIROCIN 2%, 15G (TUBE)
05/08/2022
05/15/2022
TOPICAL
2%
Bid
Soft Tissue Infection
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: