Cula, Nairan M.

HRN: 19-65-08  Sex: Female

Patient Encounter


AMS Audit List

Audit Date
Antimicrobial
Start Date
End Date
Route
Dose
Frequency
Indication Documented
04/08/2023
AMPICILLIN 1GM (VIAL)
04/08/2023
04/14/2023
IV
625mg
Q6hours
PCAP-B
Waiting Final Action 
04/09/2023
AMPICILLIN 1GM + SULBACTAM 500MG (VIAL)
04/09/2023
04/15/2023
IV
625mg
Q6H
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: