Extended criteria (experimental). This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects for CDI staff. The primary surface is Before you sign (kidney, measurement only). All extended pages.

ENC-00006: Wes Upfield

72F · MRN69261399 · Pulmonology · admitted Mon Nov 02, 2026 09:10 PM · discharged Tue Nov 10, 2026 11:39 AM · attending Dr. Isaac Abernath · resident Dr. Priya Thorne · 155 cm, 73.9 kg

Documented diagnoses (current)

Principal: “COPD exacerbation” · J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
“obesity” · E66.9 Obesity, unspecified
“AKI” · N17.9 Acute kidney failure, unspecified
“hypertension” · I10 Essential (primary) hypertension
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 191 Chronic obstructive pulmonary disease with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 190.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

No gap

Supported as documented (N17.9).

Trace

Rule trace (rule aki v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: meets_definition	`creat_ratio >= t.ratio_s1 or creat_rise_48h >= t.rise_abs or coalesce(uo_hours_lt_0_5 >= t.uo_s1_h, false)`	creat_ratio=2.439, t.ratio_s1=1.5, creat_rise_48h=0.36, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	true
derived: stage3	`meets_definition and (creat_ratio >= t.ratio_s3 or creat_peak >= t.scr_s3 or rrt_started or coalesce(uo_hours_lt_0_3 >= t.uo_s3_h, false) or coalesce(anuria_hours >= t.anuria_h, false))`	meets_definition=True, creat_ratio=2.439, t.ratio_s3=3.0, creat_peak=1.61, t.scr_s3=4.0, rrt_started=False, uo_hours_lt_0_3=unknown, t.uo_s3_h=24, anuria_hours=unknown, t.anuria_h=12	false
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=2.439, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	true
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=True, meets_definition=True	2
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.36, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=2, baseline_independent=True	true

Acute blood loss anaemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=F, hgb_nadir=12.57, t.hb_m=13, t.hb_f=12	false
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=0.0, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=False, anaemic=False, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=False, hgb_drop=0.0, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=12.57, anaemic=False	true

Chronic kidney disease

Clinical judgement required

No gap

Not documented; egfr 60 or above; ckd g1-g2 requires markers of kidney damage, which are not assessed here.

Trace

Rule trace (rule ckd v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: chronic	`egfr_n >= 2 and egfr_span_days >= t.chronic_days`	egfr_n=2, egfr_span_days=226, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=93.5, egfr_late=93.1	93.5
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=93.5, t.g2=60, egfr_late=93.1	false
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=93.5, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=False, egfr_early=93.5, egfr_late=93.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=93.5, t.g2=60	true

Heart failure

Clinical judgement required

No gap

Not documented; only one acute indicator; acuity needs clinical judgement.

Trace

Rule trace (rule heart_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: np_elevated	`coalesce(bnp_max >= t.bnp, false) or coalesce(ntprobnp_max >= t.ntprobnp, false)`	bnp_max=unknown, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	false
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=False, np_elevated=False, new_o2=True	1
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=unknown, t.ref=40, t.pres=50	unknown
derived: improved	`coalesce(lvef_prior_min <= t.ref and lvef > t.ref and lvef - lvef_prior_min >= t.improved_rise, false)`	lvef_prior_min=unknown, t.ref=40, lvef=unknown, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=1, hf_history=False	unknown
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=unknown	unknown
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: one_indicator	`acute_count == 1`	acute_count=1	true

Hyponatraemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=137.0, t.profound=125, t.moderate=130, t.low=135	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=137.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=137.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=137.0, t.low=135	true

Malnutrition

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule malnutrition v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: a_sev_intake	`intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days`	intake_pct=unknown, t.a_sev_intake_pct=50, intake_days=unknown, t.a_sev_intake_days=5	unknown
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=unknown, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7	unknown
derived: a_sev_wt	`(wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: a_mod_wt	`(wt_loss_days <= 7 and wt_loss_pct >= 1) or (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_sev_wt	`(wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_mod_wt	`(wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) or (wt_loss_days <= 183 and wt_loss_pct >= 10) or (wt_loss_days <= 366 and wt_loss_pct >= 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=unknown, wt_loss_pct=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown	0
derived: n_severe	`case(nutr_context == 'acute', count(a_sev_intake, a_sev_wt, fat_loss >= 2, muscle_loss >= 2, fluid >= 2, grip_reduced), nutr_context == 'chronic', count(c_sev_intake, c_sev_wt, fat_loss >= 3, muscle_loss >= 3, fluid >= 3, grip_reduced), null)`	nutr_context=unknown, a_sev_intake=unknown, a_sev_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_sev_wt=unknown	unknown
derived: n_moderate	`case(nutr_context == 'acute', count(a_sev_intake or a_mod_intake, a_sev_wt or a_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), nutr_context == 'chronic', count(c_sev_intake or c_mod_intake, c_sev_wt or c_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), null)`	nutr_context=unknown, a_sev_intake=unknown, a_mod_intake=unknown, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_mod_intake=unknown, c_sev_wt=unknown, c_mod_wt=unknown	unknown
outcome: severe	`n_severe >= 2`	n_severe=unknown	unknown
outcome: moderate	`n_moderate >= 2`	n_moderate=unknown	unknown
outcome: one_characteristic	`n_moderate == 1`	n_moderate=unknown	unknown
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=unknown, n_assessed=0	false

Obesity

Criteria met

Specificity gap

Documented “obesity” (E66.9); criteria support the more specific Obesity, class 1 (E66.811).

Trace

Rule trace (rule obesity v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=72, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=30.8, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=30.8, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=30.8, t.c1=30	true

Pressure injury

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule pressure_injury v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sacral	`wound_site == 'sacral'`	wound_site=unknown	unknown
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=unknown	true

Acute respiratory failure

Criteria met

Specificity gap

Criteria support Acute respiratory failure with hypoxia (J96.01); no corresponding diagnosis is documented.

Trace

Rule trace (rule respiratory_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: measured	`present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min)`	spo2_min_ra=86.0, pao2_min_ra=53.0, pf_min=252	true
derived: hypoxemia	`coalesce(spo2_min_ra < t.spo2_ra, false) or coalesce(pao2_min_ra < t.pao2, false) or coalesce(pf_min < t.pf, false)`	spo2_min_ra=86.0, t.spo2_ra=88, pao2_min_ra=53.0, t.pao2=60, pf_min=252, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=31.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	true
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=True	false
outcome: met	`hypoxemia and distress`	hypoxemia=True, distress=True	true

Sepsis

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=37.3, t.t_hi=38, temp_min_48h=36.5, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=87.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=31.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	true
derived: sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`	wbc_max_48h=10.38, t.wbc_hi=12, wbc_min_48h=5.94, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	false
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=False, sirs_hr=False, sirs_rr=True, sirs_wbc=False	1
derived: sofa_resp	`coalesce(case(pf_min_48h < 100 and adv_resp_support, 4, pf_min_48h < 200 and adv_resp_support, 3, pf_min_48h < 300, 2, pf_min_48h < 400, 1, 0), 0)`	pf_min_48h=252, adv_resp_support=False	2
derived: sofa_coag	`coalesce(case(platelets_min_48h < 20, 4, platelets_min_48h < 50, 3, platelets_min_48h < 100, 2, platelets_min_48h < 150, 1, 0), 0)`	platelets_min_48h=200.0	0
derived: sofa_liver	`coalesce(case(bili_max_48h >= 12, 4, bili_max_48h >= 6, 3, bili_max_48h >= 2, 2, bili_max_48h >= 1.2, 1, 0), 0)`	bili_max_48h=0.85	0
derived: sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`	norepi_max_48h=0.0, map_min_48h=74.0	0
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=1.61	1
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=0.66	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=2, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=1, sofa_renal_baseline=0	3
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=3, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, sirs_count=1, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=False, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=False	true

Structured data

Labs (50)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-000175	Fri Dec 26, 2025 09:15 AM	creatinine	0.65 mg/dL
LAB-000176	Mon Aug 10, 2026 10:05 AM	creatinine	0.66 mg/dL
LAB-000186	Mon Nov 02, 2026 09:35 PM	pao2	53.0 mmHg
LAB-000187	Mon Nov 02, 2026 09:35 PM	fio2	21.0 %
LAB-000177	Mon Nov 02, 2026 10:10 PM	creatinine	1.25 mg/dL
LAB-000188	Mon Nov 02, 2026 10:10 PM	sodium	139.0 mmol/L
LAB-000197	Mon Nov 02, 2026 10:10 PM	hemoglobin	12.57 g/dL
LAB-000206	Mon Nov 02, 2026 10:10 PM	wbc	7.29 x10^3/uL
LAB-000207	Mon Nov 02, 2026 10:10 PM	platelets	228.0 x10^3/uL
LAB-000224	Mon Nov 02, 2026 10:10 PM	bilirubin	0.85 mg/dL
LAB-000178	Tue Nov 03, 2026 05:00 AM	creatinine	1.61 mg/dL
LAB-000189	Tue Nov 03, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-000198	Tue Nov 03, 2026 05:00 AM	hemoglobin	13.09 g/dL
LAB-000208	Tue Nov 03, 2026 05:00 AM	wbc	10.38 x10^3/uL
LAB-000209	Tue Nov 03, 2026 05:00 AM	platelets	214.0 x10^3/uL
LAB-000179	Wed Nov 04, 2026 05:00 AM	creatinine	1.44 mg/dL
LAB-000190	Wed Nov 04, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-000199	Wed Nov 04, 2026 05:00 AM	hemoglobin	12.73 g/dL
LAB-000210	Wed Nov 04, 2026 05:00 AM	wbc	5.94 x10^3/uL
LAB-000211	Wed Nov 04, 2026 05:00 AM	platelets	200.0 x10^3/uL
LAB-000180	Thu Nov 05, 2026 05:00 AM	creatinine	1.2 mg/dL
LAB-000191	Thu Nov 05, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-000200	Thu Nov 05, 2026 05:00 AM	hemoglobin	12.67 g/dL
LAB-000212	Thu Nov 05, 2026 05:00 AM	wbc	6.98 x10^3/uL
LAB-000213	Thu Nov 05, 2026 05:00 AM	platelets	268.0 x10^3/uL
LAB-000181	Fri Nov 06, 2026 05:00 AM	creatinine	1.0 mg/dL
LAB-000192	Fri Nov 06, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-000201	Fri Nov 06, 2026 05:00 AM	hemoglobin	12.61 g/dL
LAB-000214	Fri Nov 06, 2026 05:00 AM	wbc	9.75 x10^3/uL
LAB-000215	Fri Nov 06, 2026 05:00 AM	platelets	295.0 x10^3/uL
LAB-000182	Sat Nov 07, 2026 05:00 AM	creatinine	0.88 mg/dL
LAB-000193	Sat Nov 07, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-000202	Sat Nov 07, 2026 05:00 AM	hemoglobin	12.74 g/dL
LAB-000216	Sat Nov 07, 2026 05:00 AM	wbc	7.71 x10^3/uL
LAB-000217	Sat Nov 07, 2026 05:00 AM	platelets	294.0 x10^3/uL
LAB-000183	Sun Nov 08, 2026 05:00 AM	creatinine	0.8 mg/dL
LAB-000194	Sun Nov 08, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-000203	Sun Nov 08, 2026 05:00 AM	hemoglobin	12.73 g/dL
LAB-000218	Sun Nov 08, 2026 05:00 AM	wbc	8.55 x10^3/uL
LAB-000219	Sun Nov 08, 2026 05:00 AM	platelets	221.0 x10^3/uL
LAB-000184	Mon Nov 09, 2026 05:00 AM	creatinine	0.77 mg/dL
LAB-000195	Mon Nov 09, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-000204	Mon Nov 09, 2026 05:00 AM	hemoglobin	13.08 g/dL
LAB-000220	Mon Nov 09, 2026 05:00 AM	wbc	5.73 x10^3/uL
LAB-000221	Mon Nov 09, 2026 05:00 AM	platelets	286.0 x10^3/uL
LAB-000185	Tue Nov 10, 2026 05:00 AM	creatinine	0.75 mg/dL
LAB-000196	Tue Nov 10, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-000205	Tue Nov 10, 2026 05:00 AM	hemoglobin	12.78 g/dL
LAB-000222	Tue Nov 10, 2026 05:00 AM	wbc	8.77 x10^3/uL
LAB-000223	Tue Nov 10, 2026 05:00 AM	platelets	221.0 x10^3/uL

Vitals (161)

Vitals
Row	When	Kind	Value	Detail
VIT-000491	Mon Nov 02, 2026 09:30 PM	spo2	86.0	room air
VIT-000492	Mon Nov 02, 2026 09:30 PM	rr	31.0
VIT-000560	Mon Nov 02, 2026 09:30 PM	temp_c	37.3
VIT-000561	Mon Nov 02, 2026 09:30 PM	hr	86.0
VIT-000562	Mon Nov 02, 2026 09:30 PM	map	80.0
VIT-000563	Mon Nov 02, 2026 09:30 PM	gcs	15.0
VIT-000493	Mon Nov 02, 2026 09:40 PM	o2_lpm	5.0	nasal cannula
VIT-000494	Tue Nov 03, 2026 05:30 AM	spo2	95.0	nasal cannula
VIT-000495	Tue Nov 03, 2026 05:30 AM	rr	22.0
VIT-000496	Tue Nov 03, 2026 05:30 AM	o2_lpm	2.0	nasal cannula
VIT-000564	Tue Nov 03, 2026 05:30 AM	temp_c	36.7
VIT-000565	Tue Nov 03, 2026 05:30 AM	hr	82.0
VIT-000566	Tue Nov 03, 2026 05:30 AM	map	89.0
VIT-000567	Tue Nov 03, 2026 05:30 AM	gcs	15.0
VIT-000497	Tue Nov 03, 2026 01:30 PM	spo2	92.0	nasal cannula
VIT-000498	Tue Nov 03, 2026 01:30 PM	rr	25.0
VIT-000499	Tue Nov 03, 2026 01:30 PM	o2_lpm	3.0	nasal cannula
VIT-000568	Tue Nov 03, 2026 01:30 PM	temp_c	37.3
VIT-000569	Tue Nov 03, 2026 01:30 PM	hr	74.0
VIT-000570	Tue Nov 03, 2026 01:30 PM	map	78.0
VIT-000571	Tue Nov 03, 2026 01:30 PM	gcs	15.0
VIT-000500	Tue Nov 03, 2026 09:30 PM	spo2	95.0	nasal cannula
VIT-000501	Tue Nov 03, 2026 09:30 PM	rr	26.0
VIT-000502	Tue Nov 03, 2026 09:30 PM	o2_lpm	4.0	nasal cannula
VIT-000572	Tue Nov 03, 2026 09:30 PM	temp_c	37.3
VIT-000573	Tue Nov 03, 2026 09:30 PM	hr	87.0
VIT-000574	Tue Nov 03, 2026 09:30 PM	map	80.0
VIT-000575	Tue Nov 03, 2026 09:30 PM	gcs	15.0
VIT-000503	Wed Nov 04, 2026 05:30 AM	spo2	94.0	nasal cannula
VIT-000504	Wed Nov 04, 2026 05:30 AM	rr	23.0
VIT-000505	Wed Nov 04, 2026 05:30 AM	o2_lpm	2.0	nasal cannula
VIT-000576	Wed Nov 04, 2026 05:30 AM	temp_c	36.5
VIT-000577	Wed Nov 04, 2026 05:30 AM	hr	69.0
VIT-000578	Wed Nov 04, 2026 05:30 AM	map	74.0
VIT-000579	Wed Nov 04, 2026 05:30 AM	gcs	15.0
VIT-000506	Wed Nov 04, 2026 01:30 PM	spo2	95.0	nasal cannula
VIT-000507	Wed Nov 04, 2026 01:30 PM	rr	25.0
VIT-000508	Wed Nov 04, 2026 01:30 PM	o2_lpm	2.0	nasal cannula
VIT-000580	Wed Nov 04, 2026 01:30 PM	temp_c	36.8
VIT-000581	Wed Nov 04, 2026 01:30 PM	hr	82.0
VIT-000582	Wed Nov 04, 2026 01:30 PM	map	78.0
VIT-000583	Wed Nov 04, 2026 01:30 PM	gcs	15.0
VIT-000509	Wed Nov 04, 2026 09:30 PM	spo2	92.0	nasal cannula
VIT-000510	Wed Nov 04, 2026 09:30 PM	rr	25.0
VIT-000511	Wed Nov 04, 2026 09:30 PM	o2_lpm	2.0	nasal cannula
VIT-000584	Wed Nov 04, 2026 09:30 PM	temp_c	36.5
VIT-000585	Wed Nov 04, 2026 09:30 PM	hr	78.0
VIT-000586	Wed Nov 04, 2026 09:30 PM	map	77.0
VIT-000587	Wed Nov 04, 2026 09:30 PM	gcs	15.0
VIT-000512	Thu Nov 05, 2026 05:30 AM	spo2	92.0	nasal cannula
VIT-000513	Thu Nov 05, 2026 05:30 AM	rr	22.0
VIT-000514	Thu Nov 05, 2026 05:30 AM	o2_lpm	2.0	nasal cannula
VIT-000588	Thu Nov 05, 2026 05:30 AM	temp_c	37.4
VIT-000589	Thu Nov 05, 2026 05:30 AM	hr	86.0
VIT-000590	Thu Nov 05, 2026 05:30 AM	map	77.0
VIT-000591	Thu Nov 05, 2026 05:30 AM	gcs	15.0
VIT-000515	Thu Nov 05, 2026 01:30 PM	spo2	95.0	nasal cannula
VIT-000516	Thu Nov 05, 2026 01:30 PM	rr	24.0
VIT-000517	Thu Nov 05, 2026 01:30 PM	o2_lpm	4.0	nasal cannula
VIT-000592	Thu Nov 05, 2026 01:30 PM	temp_c	36.8
VIT-000593	Thu Nov 05, 2026 01:30 PM	hr	73.0
VIT-000594	Thu Nov 05, 2026 01:30 PM	map	78.0
VIT-000595	Thu Nov 05, 2026 01:30 PM	gcs	15.0
VIT-000518	Thu Nov 05, 2026 09:30 PM	spo2	94.0	nasal cannula
VIT-000519	Thu Nov 05, 2026 09:30 PM	rr	20.0
VIT-000520	Thu Nov 05, 2026 09:30 PM	o2_lpm	4.0	nasal cannula
VIT-000596	Thu Nov 05, 2026 09:30 PM	temp_c	37.2
VIT-000597	Thu Nov 05, 2026 09:30 PM	hr	84.0
VIT-000598	Thu Nov 05, 2026 09:30 PM	map	83.0
VIT-000599	Thu Nov 05, 2026 09:30 PM	gcs	15.0
VIT-000521	Fri Nov 06, 2026 05:30 AM	spo2	95.0	nasal cannula
VIT-000522	Fri Nov 06, 2026 05:30 AM	rr	23.0
VIT-000523	Fri Nov 06, 2026 05:30 AM	o2_lpm	3.0	nasal cannula
VIT-000600	Fri Nov 06, 2026 05:30 AM	temp_c	36.9
VIT-000601	Fri Nov 06, 2026 05:30 AM	hr	84.0
VIT-000602	Fri Nov 06, 2026 05:30 AM	map	76.0
VIT-000603	Fri Nov 06, 2026 05:30 AM	gcs	15.0
VIT-000524	Fri Nov 06, 2026 01:30 PM	spo2	93.0	nasal cannula
VIT-000525	Fri Nov 06, 2026 01:30 PM	rr	22.0
VIT-000526	Fri Nov 06, 2026 01:30 PM	o2_lpm	2.0	nasal cannula
VIT-000604	Fri Nov 06, 2026 01:30 PM	temp_c	37.6
VIT-000605	Fri Nov 06, 2026 01:30 PM	hr	73.0
VIT-000606	Fri Nov 06, 2026 01:30 PM	map	78.0
VIT-000607	Fri Nov 06, 2026 01:30 PM	gcs	15.0
VIT-000527	Fri Nov 06, 2026 09:30 PM	spo2	91.0	nasal cannula
VIT-000528	Fri Nov 06, 2026 09:30 PM	rr	26.0
VIT-000529	Fri Nov 06, 2026 09:30 PM	o2_lpm	4.0	nasal cannula
VIT-000608	Fri Nov 06, 2026 09:30 PM	temp_c	36.6
VIT-000609	Fri Nov 06, 2026 09:30 PM	hr	78.0
VIT-000610	Fri Nov 06, 2026 09:30 PM	map	86.0
VIT-000611	Fri Nov 06, 2026 09:30 PM	gcs	15.0
VIT-000530	Sat Nov 07, 2026 05:30 AM	spo2	95.0	nasal cannula
VIT-000531	Sat Nov 07, 2026 05:30 AM	rr	22.0
VIT-000532	Sat Nov 07, 2026 05:30 AM	o2_lpm	3.0	nasal cannula
VIT-000612	Sat Nov 07, 2026 05:30 AM	temp_c	36.7
VIT-000613	Sat Nov 07, 2026 05:30 AM	hr	83.0
VIT-000614	Sat Nov 07, 2026 05:30 AM	map	83.0
VIT-000615	Sat Nov 07, 2026 05:30 AM	gcs	15.0
VIT-000533	Sat Nov 07, 2026 01:30 PM	spo2	95.0	nasal cannula
VIT-000534	Sat Nov 07, 2026 01:30 PM	rr	22.0
VIT-000535	Sat Nov 07, 2026 01:30 PM	o2_lpm	4.0	nasal cannula
VIT-000616	Sat Nov 07, 2026 01:30 PM	temp_c	37.6
VIT-000617	Sat Nov 07, 2026 01:30 PM	hr	91.0
VIT-000618	Sat Nov 07, 2026 01:30 PM	map	86.0
VIT-000619	Sat Nov 07, 2026 01:30 PM	gcs	15.0
VIT-000536	Sat Nov 07, 2026 09:30 PM	spo2	91.0	nasal cannula
VIT-000537	Sat Nov 07, 2026 09:30 PM	rr	22.0
VIT-000538	Sat Nov 07, 2026 09:30 PM	o2_lpm	2.0	nasal cannula
VIT-000620	Sat Nov 07, 2026 09:30 PM	temp_c	37.0
VIT-000621	Sat Nov 07, 2026 09:30 PM	hr	90.0
VIT-000622	Sat Nov 07, 2026 09:30 PM	map	83.0
VIT-000623	Sat Nov 07, 2026 09:30 PM	gcs	15.0
VIT-000539	Sun Nov 08, 2026 05:30 AM	spo2	93.0	nasal cannula
VIT-000540	Sun Nov 08, 2026 05:30 AM	rr	20.0
VIT-000541	Sun Nov 08, 2026 05:30 AM	o2_lpm	2.0	nasal cannula
VIT-000624	Sun Nov 08, 2026 05:30 AM	temp_c	36.5
VIT-000625	Sun Nov 08, 2026 05:30 AM	hr	79.0
VIT-000626	Sun Nov 08, 2026 05:30 AM	map	82.0
VIT-000627	Sun Nov 08, 2026 05:30 AM	gcs	15.0
VIT-000542	Sun Nov 08, 2026 01:30 PM	spo2	94.0	nasal cannula
VIT-000543	Sun Nov 08, 2026 01:30 PM	rr	22.0
VIT-000544	Sun Nov 08, 2026 01:30 PM	o2_lpm	2.0	nasal cannula
VIT-000628	Sun Nov 08, 2026 01:30 PM	temp_c	36.8
VIT-000629	Sun Nov 08, 2026 01:30 PM	hr	89.0
VIT-000630	Sun Nov 08, 2026 01:30 PM	map	92.0
VIT-000631	Sun Nov 08, 2026 01:30 PM	gcs	15.0
VIT-000545	Sun Nov 08, 2026 09:30 PM	spo2	94.0	nasal cannula
VIT-000546	Sun Nov 08, 2026 09:30 PM	rr	24.0
VIT-000547	Sun Nov 08, 2026 09:30 PM	o2_lpm	3.0	nasal cannula
VIT-000632	Sun Nov 08, 2026 09:30 PM	temp_c	37.5
VIT-000633	Sun Nov 08, 2026 09:30 PM	hr	69.0
VIT-000634	Sun Nov 08, 2026 09:30 PM	map	77.0
VIT-000635	Sun Nov 08, 2026 09:30 PM	gcs	15.0
VIT-000548	Mon Nov 09, 2026 05:30 AM	spo2	93.0	nasal cannula
VIT-000549	Mon Nov 09, 2026 05:30 AM	rr	21.0
VIT-000550	Mon Nov 09, 2026 05:30 AM	o2_lpm	3.0	nasal cannula
VIT-000636	Mon Nov 09, 2026 05:30 AM	temp_c	36.9
VIT-000637	Mon Nov 09, 2026 05:30 AM	hr	72.0
VIT-000638	Mon Nov 09, 2026 05:30 AM	map	78.0
VIT-000639	Mon Nov 09, 2026 05:30 AM	gcs	15.0
VIT-000551	Mon Nov 09, 2026 01:30 PM	spo2	92.0	nasal cannula
VIT-000552	Mon Nov 09, 2026 01:30 PM	rr	24.0
VIT-000553	Mon Nov 09, 2026 01:30 PM	o2_lpm	4.0	nasal cannula
VIT-000640	Mon Nov 09, 2026 01:30 PM	temp_c	36.5
VIT-000641	Mon Nov 09, 2026 01:30 PM	hr	88.0
VIT-000642	Mon Nov 09, 2026 01:30 PM	map	83.0
VIT-000643	Mon Nov 09, 2026 01:30 PM	gcs	15.0
VIT-000554	Mon Nov 09, 2026 09:30 PM	spo2	91.0	nasal cannula
VIT-000555	Mon Nov 09, 2026 09:30 PM	rr	26.0
VIT-000556	Mon Nov 09, 2026 09:30 PM	o2_lpm	3.0	nasal cannula
VIT-000644	Mon Nov 09, 2026 09:30 PM	temp_c	36.9
VIT-000645	Mon Nov 09, 2026 09:30 PM	hr	77.0
VIT-000646	Mon Nov 09, 2026 09:30 PM	map	88.0
VIT-000647	Mon Nov 09, 2026 09:30 PM	gcs	15.0
VIT-000557	Tue Nov 10, 2026 05:30 AM	spo2	94.0	nasal cannula
VIT-000558	Tue Nov 10, 2026 05:30 AM	rr	24.0
VIT-000559	Tue Nov 10, 2026 05:30 AM	o2_lpm	2.0	nasal cannula
VIT-000648	Tue Nov 10, 2026 05:30 AM	temp_c	36.7
VIT-000649	Tue Nov 10, 2026 05:30 AM	hr	92.0
VIT-000650	Tue Nov 10, 2026 05:30 AM	map	83.0
VIT-000651	Tue Nov 10, 2026 05:30 AM	gcs	15.0

Medications, orders, echo, history (0)

Notes

History and physical · DOC-000018 · Dr. Priya Thorne (resident) · Tue Nov 03, 2026 12:10 AM

Source document DOC-000018: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Wes Upfield   MRN: MRN69261399   Admitted: 2026-11-02 21:10
Service: Pulmonology   Attending: Dr. Isaac Abernath

History of present illness: 72-year-old woman admitted with COPD exacerbation. 
Past medical history: hypertension, hyperlipidemia, GERD.
Review of systems otherwise negative.
Exam: Lungs: labored respirations.
Assessment and plan:
1. COPD exacerbation: bronchodilators and steroids.

Progress note · DOC-000019 · Dr. Priya Thorne (resident) · Thu Nov 05, 2026 01:10 AM

Source document DOC-000019: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Wes Upfield   MRN: MRN69261399   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. COPD exacerbation: continue current management.
2. Obesity: counsel on weight.
3. AKI: trend creatinine, hold nephrotoxins, strict intake and output.

Resident: Dr. Priya Thorne   Attending cosign: completed

Discharge summary · DOC-000020 · Dr. Isaac Abernath (attending) · Tue Nov 10, 2026 11:39 AM

Source document DOC-000020: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Wes Upfield   MRN: MRN69261399
Admitted 2026-11-02; discharged 2026-11-10.

Discharge diagnoses:
- COPD exacerbation
- obesity
- AKI
- hypertension
- hyperlipidemia
- GERD

Disposition: home with follow-up.