Alpha, Fitriana .

HRN: 19-24-41  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
01/14/2023
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
01/14/2023
01/21/2023
IVT
225mg
Q6
Atopic Dermatitis/ Uti
Waiting Final Action 
01/16/2023
CO-AMOXICLAV 457MG/5ML, 70ML SUSPENSION (BOT)
01/16/2023
01/23/2023
PO
2 Ml
BID
T/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: