Sakilan, Baby Boy .

HRN: 22-76-77  Sex: Male

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/05/2023
AMPICILLIN 250MG (VIAL)
04/05/2023
04/12/2023
IV
135mg
Q12
Potentially Septic Newborn
Waiting Final Action 
04/05/2023
GENTAMICIN 40MG/ML, 2ML (AMP)
04/05/2023
04/12/2023
IV
14mg
Q24hr
Potentially Septic Newborn
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: