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-00010: Quinn Kowalczyk

50M · MRN47067770 · Pulmonology · admitted Mon Nov 09, 2026 10:30 PM · in hospital · attending Dr. Cyrus Ellingham · resident Dr. Greta Kowalczyk · 162 cm, 60.4 kg

Documented diagnoses (current)

Principal: “COPD exacerbation” · J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 192 Chronic obstructive pulmonary disease without CC/MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 192.

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=1.054, t.ratio_s1=1.5, creat_rise_48h=0.09, 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=1.054, t.ratio_s3=3.0, creat_peak=1.36, 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=1.054, 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=0.09, 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 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=M, hgb_nadir=13.81, 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=0.3, 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=0.3, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=13.81, 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=199, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=69.5, egfr_late=67.5	69.5
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=69.5, t.g2=60, egfr_late=67.5	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=69.5, 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=69.5, egfr_late=67.5, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=69.5, t.g2=60	true

Heart failure

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=False	0
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=0, 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=0	false

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

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=50, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=23.0, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=23.0, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=23.0, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=23.0, 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=37.1, 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=78.0, 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=10.6, t.wbc_hi=12, wbc_min_48h=9.23, 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=231.0	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=0.53	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=75.0	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=1.33	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=1.29	1
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=1, sofa_renal_baseline=1	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, 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=False	true

Structured data

Labs (28)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-000321	Thu Jan 22, 2026 09:15 AM	creatinine	1.26 mg/dL
LAB-000322	Mon Aug 10, 2026 10:05 AM	creatinine	1.29 mg/dL
LAB-000323	Mon Nov 09, 2026 11:30 PM	creatinine	1.3 mg/dL
LAB-000328	Mon Nov 09, 2026 11:30 PM	sodium	137.0 mmol/L
LAB-000333	Mon Nov 09, 2026 11:30 PM	hemoglobin	13.82 g/dL
LAB-000338	Mon Nov 09, 2026 11:30 PM	wbc	10.19 x10^3/uL
LAB-000339	Mon Nov 09, 2026 11:30 PM	platelets	248.0 x10^3/uL
LAB-000348	Mon Nov 09, 2026 11:30 PM	bilirubin	0.53 mg/dL
LAB-000324	Tue Nov 10, 2026 05:00 AM	creatinine	1.27 mg/dL
LAB-000329	Tue Nov 10, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-000334	Tue Nov 10, 2026 05:00 AM	hemoglobin	14.09 g/dL
LAB-000340	Tue Nov 10, 2026 05:00 AM	wbc	10.6 x10^3/uL
LAB-000341	Tue Nov 10, 2026 05:00 AM	platelets	240.0 x10^3/uL
LAB-000325	Wed Nov 11, 2026 05:00 AM	creatinine	1.33 mg/dL
LAB-000330	Wed Nov 11, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-000335	Wed Nov 11, 2026 05:00 AM	hemoglobin	13.81 g/dL
LAB-000342	Wed Nov 11, 2026 05:00 AM	wbc	9.23 x10^3/uL
LAB-000343	Wed Nov 11, 2026 05:00 AM	platelets	231.0 x10^3/uL
LAB-000326	Thu Nov 12, 2026 05:00 AM	creatinine	1.36 mg/dL
LAB-000331	Thu Nov 12, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-000336	Thu Nov 12, 2026 05:00 AM	hemoglobin	14.08 g/dL
LAB-000344	Thu Nov 12, 2026 05:00 AM	wbc	5.62 x10^3/uL
LAB-000345	Thu Nov 12, 2026 05:00 AM	platelets	230.0 x10^3/uL
LAB-000327	Fri Nov 13, 2026 05:00 AM	creatinine	1.27 mg/dL
LAB-000332	Fri Nov 13, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-000337	Fri Nov 13, 2026 05:00 AM	hemoglobin	14.37 g/dL
LAB-000346	Fri Nov 13, 2026 05:00 AM	wbc	8.15 x10^3/uL
LAB-000347	Fri Nov 13, 2026 05:00 AM	platelets	279.0 x10^3/uL

Vitals (72)

Vitals
Row	When	Kind	Value	Detail
VIT-000934	Mon Nov 09, 2026 10:50 PM	spo2	98.0	room air
VIT-000935	Mon Nov 09, 2026 10:50 PM	rr	15.0
VIT-000958	Mon Nov 09, 2026 10:50 PM	temp_c	37.1
VIT-000959	Mon Nov 09, 2026 10:50 PM	hr	73.0
VIT-000960	Mon Nov 09, 2026 10:50 PM	map	78.0
VIT-000961	Mon Nov 09, 2026 10:50 PM	gcs	15.0
VIT-000936	Tue Nov 10, 2026 06:50 AM	spo2	95.0	room air
VIT-000937	Tue Nov 10, 2026 06:50 AM	rr	19.0
VIT-000962	Tue Nov 10, 2026 06:50 AM	temp_c	36.8
VIT-000963	Tue Nov 10, 2026 06:50 AM	hr	71.0
VIT-000964	Tue Nov 10, 2026 06:50 AM	map	89.0
VIT-000965	Tue Nov 10, 2026 06:50 AM	gcs	15.0
VIT-000938	Tue Nov 10, 2026 02:50 PM	spo2	98.0	room air
VIT-000939	Tue Nov 10, 2026 02:50 PM	rr	20.0
VIT-000966	Tue Nov 10, 2026 02:50 PM	temp_c	36.5
VIT-000967	Tue Nov 10, 2026 02:50 PM	hr	74.0
VIT-000968	Tue Nov 10, 2026 02:50 PM	map	75.0
VIT-000969	Tue Nov 10, 2026 02:50 PM	gcs	15.0
VIT-000940	Tue Nov 10, 2026 10:50 PM	spo2	94.0	room air
VIT-000941	Tue Nov 10, 2026 10:50 PM	rr	14.0
VIT-000970	Tue Nov 10, 2026 10:50 PM	temp_c	37.1
VIT-000971	Tue Nov 10, 2026 10:50 PM	hr	70.0
VIT-000972	Tue Nov 10, 2026 10:50 PM	map	86.0
VIT-000973	Tue Nov 10, 2026 10:50 PM	gcs	15.0
VIT-000942	Wed Nov 11, 2026 06:50 AM	spo2	97.0	room air
VIT-000943	Wed Nov 11, 2026 06:50 AM	rr	20.0
VIT-000974	Wed Nov 11, 2026 06:50 AM	temp_c	36.7
VIT-000975	Wed Nov 11, 2026 06:50 AM	hr	71.0
VIT-000976	Wed Nov 11, 2026 06:50 AM	map	77.0
VIT-000977	Wed Nov 11, 2026 06:50 AM	gcs	15.0
VIT-000944	Wed Nov 11, 2026 02:50 PM	spo2	95.0	room air
VIT-000945	Wed Nov 11, 2026 02:50 PM	rr	15.0
VIT-000978	Wed Nov 11, 2026 02:50 PM	temp_c	36.8
VIT-000979	Wed Nov 11, 2026 02:50 PM	hr	78.0
VIT-000980	Wed Nov 11, 2026 02:50 PM	map	77.0
VIT-000981	Wed Nov 11, 2026 02:50 PM	gcs	15.0
VIT-000946	Wed Nov 11, 2026 10:50 PM	spo2	98.0	room air
VIT-000947	Wed Nov 11, 2026 10:50 PM	rr	14.0
VIT-000982	Wed Nov 11, 2026 10:50 PM	temp_c	37.0
VIT-000983	Wed Nov 11, 2026 10:50 PM	hr	72.0
VIT-000984	Wed Nov 11, 2026 10:50 PM	map	85.0
VIT-000985	Wed Nov 11, 2026 10:50 PM	gcs	15.0
VIT-000948	Thu Nov 12, 2026 06:50 AM	spo2	97.0	room air
VIT-000949	Thu Nov 12, 2026 06:50 AM	rr	16.0
VIT-000986	Thu Nov 12, 2026 06:50 AM	temp_c	36.6
VIT-000987	Thu Nov 12, 2026 06:50 AM	hr	84.0
VIT-000988	Thu Nov 12, 2026 06:50 AM	map	75.0
VIT-000989	Thu Nov 12, 2026 06:50 AM	gcs	15.0
VIT-000950	Thu Nov 12, 2026 02:50 PM	spo2	96.0	room air
VIT-000951	Thu Nov 12, 2026 02:50 PM	rr	18.0
VIT-000990	Thu Nov 12, 2026 02:50 PM	temp_c	37.4
VIT-000991	Thu Nov 12, 2026 02:50 PM	hr	87.0
VIT-000992	Thu Nov 12, 2026 02:50 PM	map	89.0
VIT-000993	Thu Nov 12, 2026 02:50 PM	gcs	15.0
VIT-000952	Thu Nov 12, 2026 10:50 PM	spo2	98.0	room air
VIT-000953	Thu Nov 12, 2026 10:50 PM	rr	16.0
VIT-000994	Thu Nov 12, 2026 10:50 PM	temp_c	36.8
VIT-000995	Thu Nov 12, 2026 10:50 PM	hr	79.0
VIT-000996	Thu Nov 12, 2026 10:50 PM	map	87.0
VIT-000997	Thu Nov 12, 2026 10:50 PM	gcs	15.0
VIT-000954	Fri Nov 13, 2026 06:50 AM	spo2	97.0	room air
VIT-000955	Fri Nov 13, 2026 06:50 AM	rr	16.0
VIT-000998	Fri Nov 13, 2026 06:50 AM	temp_c	37.2
VIT-000999	Fri Nov 13, 2026 06:50 AM	hr	84.0
VIT-001000	Fri Nov 13, 2026 06:50 AM	map	80.0
VIT-001001	Fri Nov 13, 2026 06:50 AM	gcs	15.0
VIT-000956	Fri Nov 13, 2026 02:50 PM	spo2	98.0	room air
VIT-000957	Fri Nov 13, 2026 02:50 PM	rr	15.0
VIT-001002	Fri Nov 13, 2026 02:50 PM	temp_c	36.8
VIT-001003	Fri Nov 13, 2026 02:50 PM	hr	82.0
VIT-001004	Fri Nov 13, 2026 02:50 PM	map	89.0
VIT-001005	Fri Nov 13, 2026 02:50 PM	gcs	15.0

Medications, orders, echo, history (0)

Notes

History and physical · DOC-000034 · Dr. Greta Kowalczyk (resident) · Tue Nov 10, 2026 01:30 AM

Source document DOC-000034: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Quinn Kowalczyk   MRN: MRN47067770   Admitted: 2026-11-09 22:30
Service: Pulmonology   Attending: Dr. Cyrus Ellingham

History of present illness: 50-year-old man admitted with COPD exacerbation. 
Past medical history: type 2 diabetes, hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. COPD exacerbation: bronchodilators and steroids.

Nutrition assessment · DOC-000033 · Dario Larkspur, RD (dietitian) · Wed Nov 11, 2026 04:30 AM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN47067770 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

Show source for fluid_accumulation

… 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

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Quinn Kowalczyk MRN: MRN47067770 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: Quinn Kowalczyk MRN: MRN47067770 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-000033: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Quinn Kowalczyk   MRN: MRN47067770

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-000035 · Dr. Greta Kowalczyk (resident) · Fri Nov 13, 2026 03:55 PM · awaiting cosign

Source document DOC-000035: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Quinn Kowalczyk   MRN: MRN47067770   Hospital day 4

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. COPD exacerbation: continue current management.

Resident: Dr. Greta Kowalczyk   Attending cosign: pending