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    Antibiotic Audit - PdfToWord

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    Ronit1bora

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    © All Rights Reserved
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    Antibiotic Audit - PdfToWord

    Uploaded by

    Ronit1bora
    51 views4 pages

    Original Title

    Antibiotic Audit_PdfToWord

    Copyright

    © © All Rights Reserved

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    DOCX, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    51 views4 pages

    Antibiotic Audit - PdfToWord

    Uploaded by

    Ronit1bora

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    HOSPITAL ANTIBIOTIC AUDIT

    Presenting complaints: q .t

    Provisional diagnosis:

    Empirical antibiotics prescribed:

    Culture sent: /
    Culture sent before starting antibiotics:
    Reason (if antibiotic started before sending culture):

    Culture and sensitivity result:

    Date:

    Sample 2- Date: III I\-

    Sample 3- ) Date:

    De-escalation possible: Y/ De-escalation done: Y / N


    Description & Reason (if De-escalation not done):

    Restricted antibiotics used: Y/ N Restricted antibiotic form filled: Y / N

    Reason (if used):


    $/IIPCT I50SPt7AL MOM/HIC/AA/01
    ANTIBIOTIC AUDIT

    Patient Name:
    PRN:

    Treating doctor: V. .. DOA: tool &1

    Empirical antibiotics prescribed: ”

    Culture sent: / Culture sent before starting antibiotics: /

    Reason (if antibiotic started before sending culture):

    Culture and sensitivity result:

    Date: \ og

    Sample 2- Date: t

    Sample 3- Date: t

    De-escalation possible: Y/ De-escalation done: Y / N

    Oescription & Reason (i f De-escalation not done):

    Restricted antibiotics used: Y/ Restricted antibiotic form filled: Y/ N

    Reason (if used): t


    MOM/HlC/AA/01
    °°°’ ANTIBIOTIC AUDIT

    Presenting complaints:

    Provisional diagnosis:

    Empirical antibiotics prescribed: \ tw \1 \ 0•

    Culture sent: Y N Culture sent before starting antibiotics: N

    Reason (if antibiotic started before sending culture):

    Culture and sensitivity result:

    Sample 1-

    Sample 2- Date:

    Sample 3- )@. Date: \ t

    De-escalation possible: Y / De-escalation done:


    Description & Reason (if De-escalation not done):
    wl»
    Restricted antibiotics used: N Restricted antibiotic form filled: /
    YIRC7 HOSPITAL MOM/HIC/AA/01
    ANTIBIOTIC AUDIT

    Bed No: 1WW ”

    Treating doctor: V- '/ DOA: 01 â2 1\

    Empirical antibiotics prescribed:

    Culture sent: / Culture sent before starting antibiotics: /

    Reason (if antibiotic started before sending culture):

    Culture and sensitivity result:

    SampTe 2- Date: (

    Sample 3- ( Date: t

    De-escalation possible: Y/ De-escalation done: Y / N

    Description & Reason (if De-escalation not done):

    Restricted antibiotics used: Restricted antibiotic form filled:

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