Alisna, Melanie D.

HRN: 22-58-52  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
02/10/2023
CEFUROXIME 1.5GM (VIAL)
02/10/2023
02/16/2023
IVT
1.5GMS
Q8
Stat Cs
Waiting Final Action 
02/11/2023
METRONIDAZOLE 500MG (TAB)
02/11/2023
02/12/2023
PO
500 Mg
Every 8 Hours
S/P 1°LTCS
Waiting Final Action 
02/11/2023
METRONIDAZOLE 5MG/ML, 100ML (VIAL)
02/11/2023
02/12/2023
IV
500 Mg
Every 8 Hours For 3 More Doses
S/P 1°LTCS
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: