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-00007: Esme Kestrel

83M · MRN31870435 · Hospital Medicine · admitted Fri Nov 06, 2026 05:48 PM · discharged Mon Nov 09, 2026 10:47 AM · attending Dr. Odette Galloway · 174 cm, 80.8 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“chronic systolic heart failure” · I50.22 Chronic systolic (congestive) heart failure

Illustrative grouping now: MS-DRG 194 Simple pneumonia and pleurisy with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 193.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

No gap

Not documented and not supported.

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=1.046, t.ratio_s1=1.5, creat_rise_48h=0.02, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	false
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=False, creat_ratio=1.046, t.ratio_s3=3.0, creat_peak=0.91, 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=1.046, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	false
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=False, meets_definition=False	0
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.02, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria met

Specificity gap

Criteria support Acute blood loss anemia (D62); no corresponding diagnosis is documented.

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=M, hgb_nadir=9.88, t.hb_m=13, t.hb_f=12	true
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=3.0, t.drop_major=2.0, prbc_units=2, t.prbc_major=2	true
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=True	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=294, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=85.9, egfr_late=85.6	85.9
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=85.9, t.g2=60, egfr_late=85.6	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=85.9, 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=85.9, egfr_late=85.6, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=85.9, t.g2=60	true

Heart failure

Criteria met

Specificity gap

Documented “chronic systolic heart failure” (I50.22); criteria support the more specific Acute on chronic systolic (HFrEF) heart failure (I50.23).

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=1937.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	true
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=True, np_elevated=True, new_o2=False	2
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=34.0, t.ref=40, t.pres=50	systolic
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=34.0, 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=2, hf_history=True	acute on chronic
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=systolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=acute on chronic	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=136.0, 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=136.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, t.low=135	true

Malnutrition

Criteria not met

No gap

Not documented and not supported.

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=100.0, t.a_sev_intake_pct=50, intake_days=unknown, t.a_sev_intake_days=5	false
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=100.0, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7	false
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=100.0, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	false
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=100.0, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	false
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=100.0, wt_loss_pct=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown	4
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=acute, a_sev_intake=False, a_sev_wt=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=unknown	0
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=acute, a_sev_intake=False, a_mod_intake=False, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=unknown, c_mod_wt=unknown	0
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=0	false
outcome: one_characteristic	`n_moderate == 1`	n_moderate=0	false
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=0, n_assessed=4	true

Obesity

Criteria not met

No gap

Not documented and not supported.

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=83, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=26.7, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=26.7, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=26.7, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=26.7, 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 not met

No gap

Not documented and not supported.

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=94.0, pao2_min_ra=unknown, pf_min=unknown	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=94.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	false
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=20.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=False	false
outcome: met	`hypoxemia and distress`	hypoxemia=False, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=False	false
outcome: not_met	`measured and not hypoxemia and o2_max_lpm <= t.o2_low and not adv_resp_support`	measured=True, hypoxemia=False, o2_max_lpm=0.0, t.o2_low=2, adv_resp_support=False	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=37.6, t.t_hi=38, temp_min_48h=36.6, 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=20.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	false
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=10.48, t.wbc_hi=12, wbc_min_48h=7.01, 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=False, sirs_wbc=False	0
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=unknown, adv_resp_support=False	0
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=167.0	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=0.59	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=0.89	0
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=0.87	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=0, sofa_renal_baseline=0	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, sirs_count=0, 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=True	false
outcome: septic_shock	`shock`	shock=False	false
outcome: both	`sepsis3 and sepsis2`	sepsis3=False, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=False	false
outcome: definitions_disagree	`sepsis2`	sepsis2=False	false
outcome: neither	`true`	—	true

Structured data

Labs (24)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-000225	Sat Oct 18, 2025 09:15 AM	creatinine	0.86 mg/dL
LAB-000226	Sat Aug 08, 2026 10:05 AM	creatinine	0.87 mg/dL
LAB-000227	Fri Nov 06, 2026 06:48 PM	creatinine	0.89 mg/dL
LAB-000231	Fri Nov 06, 2026 06:48 PM	bnp	1937.0 pg/mL
LAB-000232	Fri Nov 06, 2026 06:48 PM	sodium	140.0 mmol/L
LAB-000236	Fri Nov 06, 2026 06:48 PM	hemoglobin	12.91 g/dL
LAB-000240	Fri Nov 06, 2026 06:48 PM	wbc	9.45 x10^3/uL
LAB-000241	Fri Nov 06, 2026 06:48 PM	platelets	301.0 x10^3/uL
LAB-000248	Fri Nov 06, 2026 06:48 PM	bilirubin	0.59 mg/dL
LAB-000228	Sat Nov 07, 2026 05:00 AM	creatinine	0.89 mg/dL
LAB-000233	Sat Nov 07, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-000237	Sat Nov 07, 2026 05:00 AM	hemoglobin	11.09 g/dL
LAB-000242	Sat Nov 07, 2026 05:00 AM	wbc	10.48 x10^3/uL
LAB-000243	Sat Nov 07, 2026 05:00 AM	platelets	167.0 x10^3/uL
LAB-000229	Sun Nov 08, 2026 05:00 AM	creatinine	0.89 mg/dL
LAB-000234	Sun Nov 08, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-000238	Sun Nov 08, 2026 05:00 AM	hemoglobin	9.88 g/dL
LAB-000244	Sun Nov 08, 2026 05:00 AM	wbc	7.01 x10^3/uL
LAB-000245	Sun Nov 08, 2026 05:00 AM	platelets	271.0 x10^3/uL
LAB-000230	Mon Nov 09, 2026 05:00 AM	creatinine	0.91 mg/dL
LAB-000235	Mon Nov 09, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-000239	Mon Nov 09, 2026 05:00 AM	hemoglobin	10.68 g/dL
LAB-000246	Mon Nov 09, 2026 05:00 AM	wbc	9.81 x10^3/uL
LAB-000247	Mon Nov 09, 2026 05:00 AM	platelets	252.0 x10^3/uL

Vitals (54)

Vitals
Row	When	Kind	Value	Detail
VIT-000652	Fri Nov 06, 2026 06:08 PM	spo2	94.0	room air
VIT-000653	Fri Nov 06, 2026 06:08 PM	rr	18.0
VIT-000670	Fri Nov 06, 2026 06:08 PM	temp_c	36.6
VIT-000671	Fri Nov 06, 2026 06:08 PM	hr	80.0
VIT-000672	Fri Nov 06, 2026 06:08 PM	map	80.0
VIT-000673	Fri Nov 06, 2026 06:08 PM	gcs	15.0
VIT-000654	Sat Nov 07, 2026 02:08 AM	spo2	95.0	room air
VIT-000655	Sat Nov 07, 2026 02:08 AM	rr	16.0
VIT-000674	Sat Nov 07, 2026 02:08 AM	temp_c	37.6
VIT-000675	Sat Nov 07, 2026 02:08 AM	hr	87.0
VIT-000676	Sat Nov 07, 2026 02:08 AM	map	84.0
VIT-000677	Sat Nov 07, 2026 02:08 AM	gcs	15.0
VIT-000656	Sat Nov 07, 2026 10:08 AM	spo2	97.0	room air
VIT-000657	Sat Nov 07, 2026 10:08 AM	rr	18.0
VIT-000678	Sat Nov 07, 2026 10:08 AM	temp_c	37.1
VIT-000679	Sat Nov 07, 2026 10:08 AM	hr	87.0
VIT-000680	Sat Nov 07, 2026 10:08 AM	map	83.0
VIT-000681	Sat Nov 07, 2026 10:08 AM	gcs	15.0
VIT-000658	Sat Nov 07, 2026 06:08 PM	spo2	96.0	room air
VIT-000659	Sat Nov 07, 2026 06:08 PM	rr	18.0
VIT-000682	Sat Nov 07, 2026 06:08 PM	temp_c	37.4
VIT-000683	Sat Nov 07, 2026 06:08 PM	hr	75.0
VIT-000684	Sat Nov 07, 2026 06:08 PM	map	79.0
VIT-000685	Sat Nov 07, 2026 06:08 PM	gcs	15.0
VIT-000660	Sun Nov 08, 2026 02:08 AM	spo2	94.0	room air
VIT-000661	Sun Nov 08, 2026 02:08 AM	rr	20.0
VIT-000686	Sun Nov 08, 2026 02:08 AM	temp_c	37.0
VIT-000687	Sun Nov 08, 2026 02:08 AM	hr	76.0
VIT-000688	Sun Nov 08, 2026 02:08 AM	map	81.0
VIT-000689	Sun Nov 08, 2026 02:08 AM	gcs	15.0
VIT-000662	Sun Nov 08, 2026 10:08 AM	spo2	96.0	room air
VIT-000663	Sun Nov 08, 2026 10:08 AM	rr	20.0
VIT-000690	Sun Nov 08, 2026 10:08 AM	temp_c	36.7
VIT-000691	Sun Nov 08, 2026 10:08 AM	hr	75.0
VIT-000692	Sun Nov 08, 2026 10:08 AM	map	74.0
VIT-000693	Sun Nov 08, 2026 10:08 AM	gcs	15.0
VIT-000664	Sun Nov 08, 2026 06:08 PM	spo2	99.0	room air
VIT-000665	Sun Nov 08, 2026 06:08 PM	rr	16.0
VIT-000694	Sun Nov 08, 2026 06:08 PM	temp_c	37.2
VIT-000695	Sun Nov 08, 2026 06:08 PM	hr	83.0
VIT-000696	Sun Nov 08, 2026 06:08 PM	map	90.0
VIT-000697	Sun Nov 08, 2026 06:08 PM	gcs	15.0
VIT-000666	Mon Nov 09, 2026 02:08 AM	spo2	96.0	room air
VIT-000667	Mon Nov 09, 2026 02:08 AM	rr	20.0
VIT-000698	Mon Nov 09, 2026 02:08 AM	temp_c	36.8
VIT-000699	Mon Nov 09, 2026 02:08 AM	hr	88.0
VIT-000700	Mon Nov 09, 2026 02:08 AM	map	84.0
VIT-000701	Mon Nov 09, 2026 02:08 AM	gcs	15.0
VIT-000668	Mon Nov 09, 2026 10:08 AM	spo2	97.0	room air
VIT-000669	Mon Nov 09, 2026 10:08 AM	rr	18.0
VIT-000702	Mon Nov 09, 2026 10:08 AM	temp_c	37.2
VIT-000703	Mon Nov 09, 2026 10:08 AM	hr	87.0
VIT-000704	Mon Nov 09, 2026 10:08 AM	map	87.0
VIT-000705	Mon Nov 09, 2026 10:08 AM	gcs	15.0

Medications, orders, echo, history (13)

MED-000034 11-06 18:48 piperacillin-tazobactam per protocol IV
MED-000035 11-07 05:00 cefepime per protocol IV
MED-000036 11-08 05:00 ceftriaxone per protocol IV
MED-000037 11-06 08:00 furosemide 40 mg IV
MED-000038 11-06 20:00 furosemide 40 mg IV
MED-000039 11-07 08:00 furosemide 40 mg IV
MED-000040 11-07 20:00 furosemide 40 mg IV
MED-000041 11-08 08:00 furosemide 40 mg IV
MED-000042 11-08 20:00 furosemide 40 mg IV
ORD-000005 11-06 18:18 blood_culture: blood cultures x2
ORD-000006 11-07 09:00 transfusion_prbc: transfuse PRBC
ECH-000005 2026-11-07 echo LVEF 34.0%
HX-000005 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000022 · Dr. Odette Galloway (attending) · Fri Nov 06, 2026 08:48 PM

Cited facts from this note (2)

bleeding_source: black tarry stools · cited p. 1, line 5 · confidence 0.85

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… d with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by black tarry stools. Past medical history: heart failure with reduced ejection fraction. Review of systems otherwise negative. Exam: Lungs: clear to auscultation bilaterally. Asse …
infection_source: right lower lobe pneumonia · cited p. 1, line 5 · confidence 0.85

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… : Hospital Medicine Attending: Dr. Odette Galloway History of present illness: 83-year-old man admitted with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by black tarry stools. Past medical history: heart failure with reduced ejection fra …

Source document DOC-000022: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Esme Kestrel   MRN: MRN31870435   Admitted: 2026-11-06 17:48
Service: Hospital Medicine   Attending: Dr. Odette Galloway

History of present illness: 83-year-old man admitted with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Hospital course complicated by black tarry stools.
Past medical history: heart failure with reduced ejection fraction.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.

Nutrition assessment · DOC-000021 · Vera Pemberton, RD (dietitian) · Sat Nov 07, 2026 11:48 PM

Cited facts from this note (5)

fat_loss: none · cited p. 1, line 7 · confidence 0.90

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… MRN: MRN31870435 Context: acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. Assessment: well nourished; no malnutrition identified.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

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… e: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. Assessment: well nourished; no malnutrition identified.
intake_pct: 100 · cited p. 1, line 5 · confidence 0.90

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NUTRITION ASSESSMENT (Registered Dietitian) Patient: Esme Kestrel MRN: MRN31870435 Context: acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. …
muscle_loss: none · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. Assessment: well nourished; no malnutrition identified.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Esme Kestrel MRN: MRN31870435 Context: acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle was …

Source document DOC-000021: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Esme Kestrel   MRN: MRN31870435

Context: acute illness
Intake: eating 100% of meals.
Weight history: weight stable over the past 3 months.
Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation.
Assessment: well nourished; no malnutrition identified.

Progress note · DOC-000023 · Dr. Odette Galloway (attending) · Sun Nov 08, 2026 07:48 PM

Source document DOC-000023: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Esme Kestrel   MRN: MRN31870435   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Community-acquired pneumonia: continue current management.
2. Chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.

Attending: Dr. Odette Galloway

Discharge summary · DOC-000024 · Dr. Odette Galloway (attending) · Mon Nov 09, 2026 10:47 AM

Source document DOC-000024: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Esme Kestrel   MRN: MRN31870435
Admitted 2026-11-06; discharged 2026-11-09.

Discharge diagnoses:
- community-acquired pneumonia
- chronic systolic heart failure

Disposition: home with follow-up.