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-00027: Sana Ingram

56M · MRN52022739 · Pulmonology · admitted Mon Nov 09, 2026 04:42 PM · in hospital · attending Dr. Jalen Carrow · resident Dr. Camila Oyelaran · 162 cm, 70.5 kg

Documented diagnoses (current)

Principal: “COPD exacerbation” · J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
“CKD stage 4” · N18.4 Chronic kidney disease, stage 4 (severe)
“worsening renal function” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified
“hypertension” · I10 Essential (primary) hypertension
“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

Specificity gap

Documented “worsening renal function” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 3) (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=2.368, t.ratio_s1=1.5, creat_rise_48h=1.01, 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=2.368, t.ratio_s3=3.0, creat_peak=4.57, 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	true
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=2.368, 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=True, stage2=True, meets_definition=True	3
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=1.01, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=3, baseline_independent=True	true

Acute blood loss anaemia

Criteria met

No gap

Supported as documented (D62).

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=9.62, 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=3.3, 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

Criteria met

Clinical validation gap

Documented “CKD stage 4” (N18.4) conflicts with what the criteria support (Chronic kidney disease stage 3b, N18.32).

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=323, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=39.9, egfr_late=40.1	40.1
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=39.9, t.g2=60, egfr_late=40.1	true
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=40.1, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G3b
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=True, egfr_early=39.9, egfr_late=40.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=40.1, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3b	false
outcome: g3b	`category == 'G3b'`	category=G3b	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=56, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=26.9, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=26.9, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=26.9, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=26.9, t.c1=30	true

Pressure injury

Criteria met

Specificity gap

Criteria support Pressure injury of sacral region, stage 4 (L89.154); no corresponding diagnosis is documented.

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=sacral	true
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=4	false
outcome: other_site	`wound_site != 'sacral'`	wound_site=sacral	false
outcome: stage1	`sacral and wound_stage == '1'`	sacral=True, wound_stage=4	false
outcome: stage2	`sacral and wound_stage == '2'`	sacral=True, wound_stage=4	false
outcome: stage3	`sacral and wound_stage == '3'`	sacral=True, wound_stage=4	false
outcome: stage4	`sacral and wound_stage == '4'`	sacral=True, wound_stage=4	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=37.5, 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=88.0, 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=19.0, 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=8.98, t.wbc_hi=12, wbc_min_48h=7.29, 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=175.0	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=0.65	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=77.0	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=4.57	3
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=1.93	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=3, sofa_renal_baseline=1	2
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=2, 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-000922	Sun Nov 16, 2025 09:15 AM	creatinine	1.94 mg/dL
LAB-000923	Tue Oct 06, 2026 10:05 AM	creatinine	1.93 mg/dL
LAB-000924	Mon Nov 09, 2026 05:42 PM	creatinine	3.56 mg/dL
LAB-000929	Mon Nov 09, 2026 05:42 PM	sodium	139.0 mmol/L
LAB-000934	Mon Nov 09, 2026 05:42 PM	hemoglobin	12.89 g/dL
LAB-000939	Mon Nov 09, 2026 05:42 PM	wbc	8.98 x10^3/uL
LAB-000940	Mon Nov 09, 2026 05:42 PM	platelets	268.0 x10^3/uL
LAB-000949	Mon Nov 09, 2026 05:42 PM	bilirubin	0.65 mg/dL
LAB-000925	Tue Nov 10, 2026 05:00 AM	creatinine	4.57 mg/dL
LAB-000930	Tue Nov 10, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-000935	Tue Nov 10, 2026 05:00 AM	hemoglobin	10.93 g/dL
LAB-000941	Tue Nov 10, 2026 05:00 AM	wbc	7.78 x10^3/uL
LAB-000942	Tue Nov 10, 2026 05:00 AM	platelets	175.0 x10^3/uL
LAB-000926	Wed Nov 11, 2026 05:00 AM	creatinine	4.11 mg/dL
LAB-000931	Wed Nov 11, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-000936	Wed Nov 11, 2026 05:00 AM	hemoglobin	9.62 g/dL
LAB-000943	Wed Nov 11, 2026 05:00 AM	wbc	7.29 x10^3/uL
LAB-000944	Wed Nov 11, 2026 05:00 AM	platelets	204.0 x10^3/uL
LAB-000927	Thu Nov 12, 2026 05:00 AM	creatinine	3.43 mg/dL
LAB-000932	Thu Nov 12, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-000937	Thu Nov 12, 2026 05:00 AM	hemoglobin	10.42 g/dL
LAB-000945	Thu Nov 12, 2026 05:00 AM	wbc	9.8 x10^3/uL
LAB-000946	Thu Nov 12, 2026 05:00 AM	platelets	259.0 x10^3/uL
LAB-000928	Fri Nov 13, 2026 05:00 AM	creatinine	2.83 mg/dL
LAB-000933	Fri Nov 13, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-000938	Fri Nov 13, 2026 05:00 AM	hemoglobin	10.72 g/dL
LAB-000947	Fri Nov 13, 2026 05:00 AM	wbc	6.18 x10^3/uL
LAB-000948	Fri Nov 13, 2026 05:00 AM	platelets	217.0 x10^3/uL

Vitals (72)

Vitals
Row	When	Kind	Value	Detail
VIT-002670	Mon Nov 09, 2026 05:02 PM	spo2	97.0	room air
VIT-002671	Mon Nov 09, 2026 05:02 PM	rr	19.0
VIT-002694	Mon Nov 09, 2026 05:02 PM	temp_c	37.4
VIT-002695	Mon Nov 09, 2026 05:02 PM	hr	88.0
VIT-002696	Mon Nov 09, 2026 05:02 PM	map	89.0
VIT-002697	Mon Nov 09, 2026 05:02 PM	gcs	15.0
VIT-002672	Tue Nov 10, 2026 01:02 AM	spo2	95.0	room air
VIT-002673	Tue Nov 10, 2026 01:02 AM	rr	15.0
VIT-002698	Tue Nov 10, 2026 01:02 AM	temp_c	36.6
VIT-002699	Tue Nov 10, 2026 01:02 AM	hr	70.0
VIT-002700	Tue Nov 10, 2026 01:02 AM	map	80.0
VIT-002701	Tue Nov 10, 2026 01:02 AM	gcs	15.0
VIT-002674	Tue Nov 10, 2026 09:02 AM	spo2	95.0	room air
VIT-002675	Tue Nov 10, 2026 09:02 AM	rr	18.0
VIT-002702	Tue Nov 10, 2026 09:02 AM	temp_c	36.8
VIT-002703	Tue Nov 10, 2026 09:02 AM	hr	79.0
VIT-002704	Tue Nov 10, 2026 09:02 AM	map	90.0
VIT-002705	Tue Nov 10, 2026 09:02 AM	gcs	15.0
VIT-002676	Tue Nov 10, 2026 05:02 PM	spo2	99.0	room air
VIT-002677	Tue Nov 10, 2026 05:02 PM	rr	19.0
VIT-002706	Tue Nov 10, 2026 05:02 PM	temp_c	36.5
VIT-002707	Tue Nov 10, 2026 05:02 PM	hr	85.0
VIT-002708	Tue Nov 10, 2026 05:02 PM	map	77.0
VIT-002709	Tue Nov 10, 2026 05:02 PM	gcs	15.0
VIT-002678	Wed Nov 11, 2026 01:02 AM	spo2	99.0	room air
VIT-002679	Wed Nov 11, 2026 01:02 AM	rr	18.0
VIT-002710	Wed Nov 11, 2026 01:02 AM	temp_c	36.6
VIT-002711	Wed Nov 11, 2026 01:02 AM	hr	70.0
VIT-002712	Wed Nov 11, 2026 01:02 AM	map	88.0
VIT-002713	Wed Nov 11, 2026 01:02 AM	gcs	15.0
VIT-002680	Wed Nov 11, 2026 09:02 AM	spo2	96.0	room air
VIT-002681	Wed Nov 11, 2026 09:02 AM	rr	14.0
VIT-002714	Wed Nov 11, 2026 09:02 AM	temp_c	37.5
VIT-002715	Wed Nov 11, 2026 09:02 AM	hr	81.0
VIT-002716	Wed Nov 11, 2026 09:02 AM	map	85.0
VIT-002717	Wed Nov 11, 2026 09:02 AM	gcs	15.0
VIT-002682	Wed Nov 11, 2026 05:02 PM	spo2	96.0	room air
VIT-002683	Wed Nov 11, 2026 05:02 PM	rr	15.0
VIT-002718	Wed Nov 11, 2026 05:02 PM	temp_c	36.8
VIT-002719	Wed Nov 11, 2026 05:02 PM	hr	83.0
VIT-002720	Wed Nov 11, 2026 05:02 PM	map	83.0
VIT-002721	Wed Nov 11, 2026 05:02 PM	gcs	15.0
VIT-002684	Thu Nov 12, 2026 01:02 AM	spo2	94.0	room air
VIT-002685	Thu Nov 12, 2026 01:02 AM	rr	16.0
VIT-002722	Thu Nov 12, 2026 01:02 AM	temp_c	37.4
VIT-002723	Thu Nov 12, 2026 01:02 AM	hr	71.0
VIT-002724	Thu Nov 12, 2026 01:02 AM	map	79.0
VIT-002725	Thu Nov 12, 2026 01:02 AM	gcs	15.0
VIT-002686	Thu Nov 12, 2026 09:02 AM	spo2	95.0	room air
VIT-002687	Thu Nov 12, 2026 09:02 AM	rr	16.0
VIT-002726	Thu Nov 12, 2026 09:02 AM	temp_c	37.2
VIT-002727	Thu Nov 12, 2026 09:02 AM	hr	91.0
VIT-002728	Thu Nov 12, 2026 09:02 AM	map	79.0
VIT-002729	Thu Nov 12, 2026 09:02 AM	gcs	15.0
VIT-002688	Thu Nov 12, 2026 05:02 PM	spo2	97.0	room air
VIT-002689	Thu Nov 12, 2026 05:02 PM	rr	19.0
VIT-002730	Thu Nov 12, 2026 05:02 PM	temp_c	36.6
VIT-002731	Thu Nov 12, 2026 05:02 PM	hr	90.0
VIT-002732	Thu Nov 12, 2026 05:02 PM	map	85.0
VIT-002733	Thu Nov 12, 2026 05:02 PM	gcs	15.0
VIT-002690	Fri Nov 13, 2026 01:02 AM	spo2	96.0	room air
VIT-002691	Fri Nov 13, 2026 01:02 AM	rr	20.0
VIT-002734	Fri Nov 13, 2026 01:02 AM	temp_c	37.0
VIT-002735	Fri Nov 13, 2026 01:02 AM	hr	89.0
VIT-002736	Fri Nov 13, 2026 01:02 AM	map	86.0
VIT-002737	Fri Nov 13, 2026 01:02 AM	gcs	15.0
VIT-002692	Fri Nov 13, 2026 09:02 AM	spo2	99.0	room air
VIT-002693	Fri Nov 13, 2026 09:02 AM	rr	19.0
VIT-002738	Fri Nov 13, 2026 09:02 AM	temp_c	37.4
VIT-002739	Fri Nov 13, 2026 09:02 AM	hr	88.0
VIT-002740	Fri Nov 13, 2026 09:02 AM	map	82.0
VIT-002741	Fri Nov 13, 2026 09:02 AM	gcs	15.0

Medications, orders, echo, history (1)

ORD-000022 11-10 09:00 transfusion_prbc: transfuse PRBC

Notes

History and physical · DOC-000090 · Dr. Camila Oyelaran (resident) · Mon Nov 09, 2026 07:42 PM

Cited facts from this note (1)

bleeding_source: bright red blood per rectum · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… Service: Pulmonology Attending: Dr. Jalen Carrow History of present illness: 56-year-old man admitted with COPD exacerbation. Hospital course complicated by bright red blood per rectum. Past medical history: hyperlipidemia, hypertension, GERD. Review of systems otherwise negative. Exam: Lungs: clear to auscultation bilaterally. Assessment and …

Source document DOC-000090: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Sana Ingram   MRN: MRN52022739   Admitted: 2026-11-09 16:42
Service: Pulmonology   Attending: Dr. Jalen Carrow

History of present illness: 56-year-old man admitted with COPD exacerbation. Hospital course complicated by bright red blood per rectum.
Past medical history: hyperlipidemia, hypertension, GERD.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. COPD exacerbation: bronchodilators and steroids.
2. CKD stage 4: renally dose medications.

Wound care note · DOC-000089 · Elena Jessup, RN, CWOCN (wound_nurse) · Tue Nov 10, 2026 06:42 PM

Cited facts from this note (2)

wound_site: sacral · cited p. 1, line 4 · confidence 0.95

Show source for wound_site

WOUND CARE NOTE Patient: Sana Ingram MRN: MRN52022739 Location: sacrum Stage: 4 (NPIAP) Description: full-thickness tissue loss with palpable bone. Size: 4.7 x 3.4 x 1.2 cm. Plan: offloading every 2 hours, foam dressing, nutrition …
wound_stage: 4 · cited p. 1, line 5 · confidence 0.95

Show source for wound_stage

WOUND CARE NOTE Patient: Sana Ingram MRN: MRN52022739 Location: sacrum Stage: 4 (NPIAP) Description: full-thickness tissue loss with palpable bone. Size: 4.7 x 3.4 x 1.2 cm. Plan: offloading every 2 hours, foam dressing, nutrition consult.

Source document DOC-000089: Wound care note (synthetic)

WOUND CARE NOTE
Patient: Sana Ingram   MRN: MRN52022739

Location: sacrum
Stage: 4 (NPIAP)
Description: full-thickness tissue loss with palpable bone.
Size: 4.7 x 3.4 x 1.2 cm.
Plan: offloading every 2 hours, foam dressing, nutrition consult.

Nutrition assessment · DOC-000088 · Viggo Ravensworth, RD (dietitian) · Tue Nov 10, 2026 07:42 PM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN52022739 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: Sana Ingram MRN: MRN52022739 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: Sana Ingram MRN: MRN52022739 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-000088: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Sana Ingram   MRN: MRN52022739

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-000091 · Dr. Camila Oyelaran (resident) · Fri Nov 13, 2026 11:55 AM · awaiting cosign

Source document DOC-000091: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Sana Ingram   MRN: MRN52022739   Hospital day 4

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. COPD exacerbation: continue current management.
2. Worsening renal function: trend creatinine, avoid nephrotoxins.
3. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Resident: Dr. Camila Oyelaran   Attending cosign: pending