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-00032: Nico Hartwell

74F · MRN49251751 · Hospital Medicine · admitted Tue Nov 03, 2026 05:50 PM · discharged Fri Nov 06, 2026 03:49 PM · attending Dr. Cyrus Ellingham · resident Dr. Keira Upfield · 160 cm, 47.3 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“malnutrition” · E46 Unspecified protein-calorie malnutrition
“acute kidney injury” · 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 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

Clinical validation gap

Documented “acute kidney injury” (N17.9) but the criteria are not met: KDIGO creatinine and urine-output criteria not met.

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=1.027, 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=1.027, t.ratio_s3=3.0, creat_peak=0.76, 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=1.027, 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 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=12.48, 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=12.48, 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=267, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=84.8, egfr_late=84.8	84.8
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=84.8, t.g2=60, egfr_late=84.8	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=84.8, 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=84.8, egfr_late=84.8, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=84.8, 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=141.0, 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=141.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=141.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=141.0, t.low=135	true

Malnutrition

Clinical judgement required

Clinical judgement required: Only one consensus characteristic documented; two are required.

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=60.0, t.a_sev_intake_pct=50, intake_days=10.0, 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=60.0, t.a_mod_intake_pct=75, intake_days=10.0, t.a_mod_intake_days=7	true
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=60.0, t.c_intake_pct=75, intake_days=10.0, 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=60.0, t.c_intake_pct=75, intake_days=10.0, 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=60.0, 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=True, 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	1
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=1	false
outcome: one_characteristic	`n_moderate == 1`	n_moderate=1	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=74, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=18.5, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=18.5, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=18.5, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=18.5, 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=83.0, pao2_min_ra=55.0, pf_min=262	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=83.0, t.spo2_ra=88, pao2_min_ra=55.0, t.pao2=60, pf_min=262, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=28.0, t.rr_distress=28, wob_increased=True, 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 met

No gap

Criteria support Sepsis (Sepsis-3); not documented (this rule does not prompt for an undocumented diagnosis).

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=36.7, 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=28.0, 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=10.83, t.wbc_hi=12, wbc_min_48h=7.84, 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=262, 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=165.0	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=0.56	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=0.75	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=0.74	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=0, sofa_renal_baseline=0	2
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=2, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, 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=True, 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=True, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=True	true

Structured data

Labs (25)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001083	Fri Nov 07, 2025 09:15 AM	creatinine	0.74 mg/dL
LAB-001084	Sun Aug 02, 2026 10:05 AM	creatinine	0.74 mg/dL
LAB-001089	Tue Nov 03, 2026 06:15 PM	pao2	55.0 mmHg
LAB-001090	Tue Nov 03, 2026 06:15 PM	fio2	21.0 %
LAB-001085	Tue Nov 03, 2026 06:50 PM	creatinine	0.75 mg/dL
LAB-001091	Tue Nov 03, 2026 06:50 PM	sodium	141.0 mmol/L
LAB-001095	Tue Nov 03, 2026 06:50 PM	hemoglobin	12.48 g/dL
LAB-001099	Tue Nov 03, 2026 06:50 PM	wbc	9.7 x10^3/uL
LAB-001100	Tue Nov 03, 2026 06:50 PM	platelets	165.0 x10^3/uL
LAB-001107	Tue Nov 03, 2026 06:50 PM	bilirubin	0.56 mg/dL
LAB-001086	Wed Nov 04, 2026 05:00 AM	creatinine	0.74 mg/dL
LAB-001092	Wed Nov 04, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-001096	Wed Nov 04, 2026 05:00 AM	hemoglobin	12.54 g/dL
LAB-001101	Wed Nov 04, 2026 05:00 AM	wbc	10.83 x10^3/uL
LAB-001102	Wed Nov 04, 2026 05:00 AM	platelets	239.0 x10^3/uL
LAB-001087	Thu Nov 05, 2026 05:00 AM	creatinine	0.74 mg/dL
LAB-001093	Thu Nov 05, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-001097	Thu Nov 05, 2026 05:00 AM	hemoglobin	12.69 g/dL
LAB-001103	Thu Nov 05, 2026 05:00 AM	wbc	7.84 x10^3/uL
LAB-001104	Thu Nov 05, 2026 05:00 AM	platelets	304.0 x10^3/uL
LAB-001088	Fri Nov 06, 2026 05:00 AM	creatinine	0.76 mg/dL
LAB-001094	Fri Nov 06, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-001098	Fri Nov 06, 2026 05:00 AM	hemoglobin	12.66 g/dL
LAB-001105	Fri Nov 06, 2026 05:00 AM	wbc	8.64 x10^3/uL
LAB-001106	Fri Nov 06, 2026 05:00 AM	platelets	232.0 x10^3/uL

Vitals (63)

Vitals
Row	When	Kind	Value	Detail
VIT-003116	Tue Nov 03, 2026 06:10 PM	spo2	83.0	room air
VIT-003117	Tue Nov 03, 2026 06:10 PM	rr	28.0
VIT-003143	Tue Nov 03, 2026 06:10 PM	temp_c	37.6
VIT-003144	Tue Nov 03, 2026 06:10 PM	hr	81.0
VIT-003145	Tue Nov 03, 2026 06:10 PM	map	91.0
VIT-003146	Tue Nov 03, 2026 06:10 PM	gcs	15.0
VIT-003118	Tue Nov 03, 2026 06:20 PM	o2_lpm	4.0	nasal cannula
VIT-003119	Wed Nov 04, 2026 02:10 AM	spo2	94.0	nasal cannula
VIT-003120	Wed Nov 04, 2026 02:10 AM	rr	26.0
VIT-003121	Wed Nov 04, 2026 02:10 AM	o2_lpm	2.0	nasal cannula
VIT-003147	Wed Nov 04, 2026 02:10 AM	temp_c	37.3
VIT-003148	Wed Nov 04, 2026 02:10 AM	hr	76.0
VIT-003149	Wed Nov 04, 2026 02:10 AM	map	92.0
VIT-003150	Wed Nov 04, 2026 02:10 AM	gcs	15.0
VIT-003122	Wed Nov 04, 2026 10:10 AM	spo2	93.0	nasal cannula
VIT-003123	Wed Nov 04, 2026 10:10 AM	rr	20.0
VIT-003124	Wed Nov 04, 2026 10:10 AM	o2_lpm	2.0	nasal cannula
VIT-003151	Wed Nov 04, 2026 10:10 AM	temp_c	36.7
VIT-003152	Wed Nov 04, 2026 10:10 AM	hr	74.0
VIT-003153	Wed Nov 04, 2026 10:10 AM	map	75.0
VIT-003154	Wed Nov 04, 2026 10:10 AM	gcs	15.0
VIT-003125	Wed Nov 04, 2026 06:10 PM	spo2	92.0	nasal cannula
VIT-003126	Wed Nov 04, 2026 06:10 PM	rr	24.0
VIT-003127	Wed Nov 04, 2026 06:10 PM	o2_lpm	2.0	nasal cannula
VIT-003155	Wed Nov 04, 2026 06:10 PM	temp_c	37.2
VIT-003156	Wed Nov 04, 2026 06:10 PM	hr	87.0
VIT-003157	Wed Nov 04, 2026 06:10 PM	map	89.0
VIT-003158	Wed Nov 04, 2026 06:10 PM	gcs	15.0
VIT-003128	Thu Nov 05, 2026 02:10 AM	spo2	94.0	nasal cannula
VIT-003129	Thu Nov 05, 2026 02:10 AM	rr	26.0
VIT-003130	Thu Nov 05, 2026 02:10 AM	o2_lpm	3.0	nasal cannula
VIT-003159	Thu Nov 05, 2026 02:10 AM	temp_c	37.3
VIT-003160	Thu Nov 05, 2026 02:10 AM	hr	78.0
VIT-003161	Thu Nov 05, 2026 02:10 AM	map	75.0
VIT-003162	Thu Nov 05, 2026 02:10 AM	gcs	15.0
VIT-003131	Thu Nov 05, 2026 10:10 AM	spo2	94.0	nasal cannula
VIT-003132	Thu Nov 05, 2026 10:10 AM	rr	21.0
VIT-003133	Thu Nov 05, 2026 10:10 AM	o2_lpm	3.0	nasal cannula
VIT-003163	Thu Nov 05, 2026 10:10 AM	temp_c	37.5
VIT-003164	Thu Nov 05, 2026 10:10 AM	hr	68.0
VIT-003165	Thu Nov 05, 2026 10:10 AM	map	87.0
VIT-003166	Thu Nov 05, 2026 10:10 AM	gcs	15.0
VIT-003134	Thu Nov 05, 2026 06:10 PM	spo2	92.0	nasal cannula
VIT-003135	Thu Nov 05, 2026 06:10 PM	rr	21.0
VIT-003136	Thu Nov 05, 2026 06:10 PM	o2_lpm	2.0	nasal cannula
VIT-003167	Thu Nov 05, 2026 06:10 PM	temp_c	36.9
VIT-003168	Thu Nov 05, 2026 06:10 PM	hr	86.0
VIT-003169	Thu Nov 05, 2026 06:10 PM	map	90.0
VIT-003170	Thu Nov 05, 2026 06:10 PM	gcs	15.0
VIT-003137	Fri Nov 06, 2026 02:10 AM	spo2	93.0	nasal cannula
VIT-003138	Fri Nov 06, 2026 02:10 AM	rr	23.0
VIT-003139	Fri Nov 06, 2026 02:10 AM	o2_lpm	2.0	nasal cannula
VIT-003171	Fri Nov 06, 2026 02:10 AM	temp_c	36.8
VIT-003172	Fri Nov 06, 2026 02:10 AM	hr	83.0
VIT-003173	Fri Nov 06, 2026 02:10 AM	map	90.0
VIT-003174	Fri Nov 06, 2026 02:10 AM	gcs	15.0
VIT-003140	Fri Nov 06, 2026 10:10 AM	spo2	95.0	nasal cannula
VIT-003141	Fri Nov 06, 2026 10:10 AM	rr	21.0
VIT-003142	Fri Nov 06, 2026 10:10 AM	o2_lpm	3.0	nasal cannula
VIT-003175	Fri Nov 06, 2026 10:10 AM	temp_c	37.2
VIT-003176	Fri Nov 06, 2026 10:10 AM	hr	89.0
VIT-003177	Fri Nov 06, 2026 10:10 AM	map	89.0
VIT-003178	Fri Nov 06, 2026 10:10 AM	gcs	15.0

Medications, orders, echo, history (4)

MED-000118 11-03 18:50 ceftriaxone per protocol IV
MED-000119 11-04 05:00 ceftriaxone per protocol IV
MED-000120 11-05 05:00 cefepime per protocol IV
ORD-000026 11-03 18:20 blood_culture: blood cultures x2

Notes

History and physical · DOC-000108 · Dr. Keira Upfield (resident) · Tue Nov 03, 2026 08:50 PM

Cited facts from this note (2)

infection_source: left lower lobe pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… Hospital Medicine Attending: Dr. Cyrus Ellingham History of present illness: 74-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: hypertension, hyperlipidemia, GERD. Review of systems otherwise negative. Exam: Lungs: inc …
work_of_breathing: increased · cited p. 1, line 8 · confidence 0.90

Show source for work_of_breathing

… nia; blood cultures drawn and ceftriaxone started. Past medical history: hypertension, hyperlipidemia, GERD. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessory muscle use. Assessment and plan: 1. Community-acquired pneumonia: antibiotics.

Source document DOC-000108: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Nico Hartwell   MRN: MRN49251751   Admitted: 2026-11-03 17:50
Service: Hospital Medicine   Attending: Dr. Cyrus Ellingham

History of present illness: 74-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: hypertension, hyperlipidemia, GERD.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscle use.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.

Nutrition assessment · DOC-000107 · Viggo Ravensworth, RD (dietitian) · Wed Nov 04, 2026 08:50 PM

Cited facts from this note (6)

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

Show source for fat_loss

… acute illness Intake: estimated energy intake 60% of needs for 10 days. 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: at risk; continue calorie counts.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… 0% of needs for 10 days. 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: at risk; continue calorie counts.
intake_days: 10 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nico Hartwell MRN: MRN49251751 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. …
intake_pct: 60 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nico Hartwell MRN: MRN49251751 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. 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

… ted energy intake 60% of needs for 10 days. 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: at risk; continue calorie counts.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nico Hartwell MRN: MRN49251751 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of sub …

Source document DOC-000107: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Nico Hartwell   MRN: MRN49251751

Context: acute illness
Intake: estimated energy intake 60% of needs for 10 days.
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: at risk; continue calorie counts.

Progress note · DOC-000109 · Dr. Keira Upfield (resident) · Thu Nov 05, 2026 07:50 PM

Source document DOC-000109: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Nico Hartwell   MRN: MRN49251751   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. Malnutrition: dietitian following.
3. Acute kidney injury: trend creatinine, hold nephrotoxins, strict intake and output.

Resident: Dr. Keira Upfield   Attending cosign: completed

Discharge summary · DOC-000110 · Dr. Cyrus Ellingham (attending) · Fri Nov 06, 2026 03:49 PM

Source document DOC-000110: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Nico Hartwell   MRN: MRN49251751
Admitted 2026-11-03; discharged 2026-11-06.

Discharge diagnoses:
- community-acquired pneumonia
- malnutrition
- acute kidney injury
- hypertension
- hyperlipidemia
- GERD

Disposition: home with follow-up.