Hollis Halloway · Notes · Demo Health Record (demonstration)

Summary

Allergies

Latex (contact dermatitis)

Latest vitals

BP: 118/70
HR: 84
SpO2: 96%
Temp: 36.9 °C
Weight: 63.2 kg

2026-11-12 11:08

Active problems 5

Pancreatic adenocarcinoma
Weight loss
Gastroesophageal reflux
Hyperlipidemia
Vitamin D deficiency

Reminders

Eye examination · due in 2 months
Depression screen · due
Pneumococcal vaccine · up to date

Clinic visit note

Unsigned draft

Type: Clinic visit
Date: 2026-11-12 12:00
Author: Rhea Castellan, NP
Status: Unsigned draft
Drafted by: Clinician-typed

Edit note Signing is never blocked.

Chief complaint: fatigue, poor appetite and weight loss. S: Eating about half of usual meals for six weeks. Tired most afternoons. Seen by the dietitian this week. O: BP 118/70, HR 84. Weight 63.2 kg. Temporal wasting noted. A/P: 1. Pancreatic adenocarcinoma on chemotherapy: oncology follow-up next week. 2. Fatigue and poor appetite: oral nutrition supplement twice daily; dietitian follow-up in 2 weeks. 3. Nausea: ondansetron as needed before meals.

Visit diagnoses (as entered by the clinician)

None entered yet for this visit.

Specificity How to read this

“Draft · pending review” means the definition awaits approval by your clinical and coding reviewers.

Needs a look Nutrition (dietitian's assessment) Draft · pending review

The dietitian's assessment (Wren Halden, RD, 2026-11-09) documents 3 characteristics at the severe level and 5 at the moderate level or worse (two are required); the note does not state a nutrition diagnosis.

Note read by: AI reader and rule reader agree · no statement on this found in the note · dietitian values come from the structured assessment, not from a reader

Uses published criteria cited by title and restated in our own words (licence or permission to be obtained before commercial use).

Evidence from the record (8)

Context documented by Wren Halden, RD on 2026-11-09: chronic illness (pancreatic adenocarcinoma on chemotherapy) (Wren Halden, RD)
Energy intake: severe level · 50% of estimated needs for 42 days: about 50% of estimated energy needs for 6 weeks (Wren Halden, RD)
Weight loss: severe level · 2.8% over 1 month (65 kg on 2026-10-13 to 63.2 kg on 2026-11-12); 7.7% over 3 months (68.5 kg on 2026-08-14 to 63.2 kg on 2026-11-12); 12.2% over 6 months (72 kg on 2026-05-16 to 63.2 kg on 2026-11-12); 14% over 1 year (73.5 kg on 2025-11-12 to 63.2 kg on 2026-11-12)
Fat loss: moderate level · graded mild: mild orbital fat loss (Wren Halden, RD)
Muscle loss: moderate level · graded moderate: moderate temporal and clavicular muscle wasting (Wren Halden, RD)
Fluid accumulation: not met · graded none: no edema (Wren Halden, RD)
Grip strength: severe level · reduced: grip strength measurably reduced by hand dynamometer (Wren Halden, RD)
Low albumin 2.9 g/dL (2026-11-09) and prealbumin 12 mg/dL (2026-11-09): not a criterion in this definition.

The note has no statement on this to show. Open the dietitian's assessment (2026-11-09)

Options

Choose wording yourself, or none. Nothing is pre-selected; the list and its order are the same for every patient.

Met / not met only says whether the recorded value falls inside that definition's range. It is not a recommendation; the diagnosis is your judgement.

Needs: two or more characteristics at the moderate level or worse Record: 5 at the moderate level or worse · ✓ met
Needs: two or more characteristics at the severe level Record: 3 at the severe level · ✓ met

One click places the wording you choose in the unsigned draft as a new line at the end of the assessment (your existing wording is not changed), highlighted, for you to edit or undo before signing. Your choice and the evidence shown are recorded.

Provenance

This check is stored and can be re-run to the same result.
Inputs: 1 record item, listed under Evidence above.
Readers: AI reader and rule reader agree
What happened so far: No response yet · shown 1 time before on this visit
Offer OF-000042 in the provenance record

Reference ids (for audit)

Definition version front_malnutrition_us_consensus@1.0 · run FRUN-00047 · replay e4f88106f041…
Input ids: NA-P35-1

Who read the note

Rule reader: a fixed word list, always on.
AI reader: openrouter · openai/gpt-6.1-terra. It may only quote the note; its quotes are checked character by character and must agree with the rule reader.
The results side (values, dates, definition) never depends on either reader.

Reference ids (for audit)

Rule reader word list: front-lexicon 1.0
AI reader: openrouter · openai/gpt-6.1-terra, version openai/gpt-6.1-terra; task exactdx.front_statements@1

Published definition and source

Consensus statement: characteristics recommended for the identification and documentation of adult malnutrition

definition version 1.0

Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (White JV et al., J Acad Nutr Diet 2012;112:730-738) · 2012 · table of clinical characteristics (cite by title; do not reproduce the table or its layout) · source

Licence: cited source; wording is ours (numbers restated, no text reproduced). Source checked: not opened.

Applies only with a dietitian's nutrition assessment. Six characteristics; at least two are required. Severe: two or more at the severe level. Moderate: two or more at the moderate level or worse. Albumin and prealbumin are not criteria.

See also: VHA Directive 1438, Clinical Nutrition Management and Food and Nutrition Services (2022); GLIM criteria for the diagnosis of malnutrition (2019).

Draft definition: pending clinical and coding review. No endorsement by the cited bodies is implied.

Reference ids (for audit)

Definition key front_malnutrition_us_consensus@1.0

Relevant history

14 related items from the whole chart for fatigue, poor appetite and weight loss · related terms for fatigue, poor appetite or weight loss. Your own words first, then related terms; newest first within each.

Earlier notes 5

Nursing intake note 2026-11-12

BP 118/70, HR 84, SpO2 96%, weight 63.2 kg. (Mara Ellison, RN)

Matched on: weight (your words) · intake (related word)
Nutrition assessment 2026-11-09

Reason for referral: poor appetite and weight loss. (Wren Halden, RD)

Matched on: poor appetite (your words) · weight loss (your words) · Nutrition (related service) · dietitian (related service)
Oncology clinic visit 2026-09-13

S: Fatigue after each cycle; (Dr. Corvin Ashby (oncology))

Matched on: Fatigue (your words) · appetite (your words) · poor (your words) · weight (your words)
Clinic visit note 2026-06-15

Appetite reduced. (Dr. Imogen Vale)

Matched on: Appetite (your words) · tired (related word) · TSH (related test) · CT abdomen (related test)
Clinic visit note 2026-04-26

Weight 72.0 kg. (Rhea Castellan, NP)

Matched on: Weight (your words)

Results 4

Hemoglobin 2026-11-12

130 g/L on 2026-11-12; 125 g/L on 2026-04-26

Matched on: Hemoglobin (related test)
Albumin 2026-11-09

2.9 g/dL on 2026-11-09

Matched on: Albumin (related test)
Prealbumin 2026-11-09

12 mg/dL on 2026-11-09

Matched on: Prealbumin (related test)
TSH 2026-06-15

1.8 mIU/L on 2026-06-15

Matched on: TSH (related test)

Imaging and reports 1

CT abdomen and pelvis with contrast 2026-06-25

2.8 cm hypoenhancing mass in the pancreatic head with mild upstream ductal dilatation. (Dr. Petra Quill (radiology))

Matched on: CT abdomen (related test)

Problem list 2

Active · since 2026-08 2026-11-12

Weight loss

Matched on: Weight loss (your words)
Active · since 2026-06 2026-11-12

Pancreatic adenocarcinoma

Matched on: adenocarcinoma (related problem)

Medications 2

Active · Home medication · started 2026-11-09 2026-11-09

Oral nutrition supplement: 1 bottle by mouth twice daily

Matched on: Oral nutrition supplement (related medicine (nutrition supplement))
Active · Home medication · started 2026-09-13 2026-09-13

Ondansetron: 4 mg tablet · 1 by mouth before meals as needed

Matched on: Ondansetron (related medicine (anti-nausea)) · meals (related word)

AI-suggested terms only widen the search; every item is a real chart item quoted from its own text.

Other checks 1

Other measurements checked against published definitions (the extended set).

Agrees: nothing to do Kidney filtering rate (eGFR) over time

Kidney results 200 days apart are 60 or above (filtering rate 71.8 on 2026-04-26 and 71.8 on 2026-11-12) and the note doesn't mention kidney function.

Show the results

Details

Thresholds

Nutrition (dietitian's assessment): Applies only with a dietitian's nutrition assessment. Six characteristics; at least two are required. Severe: two or more at the severe level. Moderate: two or more at the moderate level or worse. Albumin and prealbumin are not criteria.

Rules and published sources

ckd_epi_2009@1.0 Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check) · source
ckd_epi_2021@1.0 Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation) · source
kdigo_aki_2012@1.1 KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2) · source
kdigo_ckd_2024@1.1 KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months) · source
kidney_compare@1.1 this tool's comparison rules (both directions) · source
kidney_exclusions@1.0 KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list · source
lab_units@1.1 KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g) · source
front_malnutrition_us_consensus@1.0 draft, pending review

Record

Check RUN-00047 · kidney-engine 2.0 · replay 9a7a6063bdc7…. Data for this panel (JSON).

Specificity check FRUN-00047 · front-engine 1.2 · replay e4f88106f041….

Library check LRUN-00047 · library_default_set@1.1 · library-engine 1.1 · replay 556b6e2205c0….

Decision support only: you decide and you write the note. Nothing is inserted unless you click it. DataCrafters 1.0.0 · data as of Fri Nov 13, 2026 04:55 PM