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-00034: Zara Brightwater

48F · MRN78659479 · Hospital Medicine · admitted Fri Oct 30, 2026 08:09 AM · discharged Sat Nov 07, 2026 01:31 PM · attending Dr. Gideon Zeller · resident Dr. Camila Oyelaran · 159 cm, 92.0 kg

Documented diagnoses (current)

Principal: “upper GI bleed” · K92.2 Gastrointestinal hemorrhage, unspecified
“acute kidney injury” · N17.9 Acute kidney failure, unspecified
“acute hypoxic respiratory failure” · J96.01 Acute respiratory failure with hypoxia
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified

Illustrative grouping now: MS-DRG 377 GI hemorrhage with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 377.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

No gap

Supported as documented (N17.9).

Trace

Rule trace (rule aki v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: meets_definition	`creat_ratio >= t.ratio_s1 or creat_rise_48h >= t.rise_abs or coalesce(uo_hours_lt_0_5 >= t.uo_s1_h, false)`	creat_ratio=1.701, t.ratio_s1=1.5, creat_rise_48h=0.29, 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=1.701, t.ratio_s3=3.0, creat_peak=1.31, 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=1.701, 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=True	1
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.29, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=1, 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=F, hgb_nadir=9.58, 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=2.9, 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=328, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=92.2, egfr_late=95.1	95.1
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=92.2, t.g2=60, egfr_late=95.1	false
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=95.1, 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=92.2, egfr_late=95.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=95.1, 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=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

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

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

Obesity

Criteria met

Specificity gap

Criteria support Obesity, class 2 (E66.812); no corresponding diagnosis is documented.

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=48, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=36.4, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=36.4, t.c2=35	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

No gap

Supported as documented (J96.01).

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=85.0, 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=85.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=31.0, t.rr_distress=28, wob_increased=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 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=37.4, 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=89.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=31.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	true
derived: sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`	wbc_max_48h=10.98, t.wbc_hi=12, wbc_min_48h=8.11, 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=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=181.0	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=0.73	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=1.31	1
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=0.77	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=1, sofa_renal_baseline=0	1
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=1, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, sirs_count=1, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=False, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=False	true

Structured data

Labs (48)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001147	Sun Sep 21, 2025 09:15 AM	creatinine	0.79 mg/dL
LAB-001148	Sat Aug 15, 2026 10:05 AM	creatinine	0.77 mg/dL
LAB-001149	Fri Oct 30, 2026 09:09 AM	creatinine	1.02 mg/dL
LAB-001158	Fri Oct 30, 2026 09:09 AM	sodium	142.0 mmol/L
LAB-001167	Fri Oct 30, 2026 09:09 AM	hemoglobin	12.46 g/dL
LAB-001176	Fri Oct 30, 2026 09:09 AM	wbc	10.98 x10^3/uL
LAB-001177	Fri Oct 30, 2026 09:09 AM	platelets	181.0 x10^3/uL
LAB-001194	Fri Oct 30, 2026 09:09 AM	bilirubin	0.73 mg/dL
LAB-001150	Sat Oct 31, 2026 05:00 AM	creatinine	1.31 mg/dL
LAB-001159	Sat Oct 31, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001168	Sat Oct 31, 2026 05:00 AM	hemoglobin	10.73 g/dL
LAB-001178	Sat Oct 31, 2026 05:00 AM	wbc	8.78 x10^3/uL
LAB-001179	Sat Oct 31, 2026 05:00 AM	platelets	261.0 x10^3/uL
LAB-001151	Sun Nov 01, 2026 05:00 AM	creatinine	1.17 mg/dL
LAB-001160	Sun Nov 01, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001169	Sun Nov 01, 2026 05:00 AM	hemoglobin	9.58 g/dL
LAB-001180	Sun Nov 01, 2026 05:00 AM	wbc	8.11 x10^3/uL
LAB-001181	Sun Nov 01, 2026 05:00 AM	platelets	205.0 x10^3/uL
LAB-001152	Mon Nov 02, 2026 05:00 AM	creatinine	0.98 mg/dL
LAB-001161	Mon Nov 02, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-001170	Mon Nov 02, 2026 05:00 AM	hemoglobin	10.38 g/dL
LAB-001182	Mon Nov 02, 2026 05:00 AM	wbc	6.4 x10^3/uL
LAB-001183	Mon Nov 02, 2026 05:00 AM	platelets	195.0 x10^3/uL
LAB-001153	Tue Nov 03, 2026 05:00 AM	creatinine	0.81 mg/dL
LAB-001162	Tue Nov 03, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001171	Tue Nov 03, 2026 05:00 AM	hemoglobin	10.68 g/dL
LAB-001184	Tue Nov 03, 2026 05:00 AM	wbc	10.1 x10^3/uL
LAB-001185	Tue Nov 03, 2026 05:00 AM	platelets	270.0 x10^3/uL
LAB-001154	Wed Nov 04, 2026 05:00 AM	creatinine	0.81 mg/dL
LAB-001163	Wed Nov 04, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001172	Wed Nov 04, 2026 05:00 AM	hemoglobin	10.78 g/dL
LAB-001186	Wed Nov 04, 2026 05:00 AM	wbc	10.07 x10^3/uL
LAB-001187	Wed Nov 04, 2026 05:00 AM	platelets	188.0 x10^3/uL
LAB-001155	Thu Nov 05, 2026 05:00 AM	creatinine	0.81 mg/dL
LAB-001164	Thu Nov 05, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-001173	Thu Nov 05, 2026 05:00 AM	hemoglobin	10.78 g/dL
LAB-001188	Thu Nov 05, 2026 05:00 AM	wbc	6.05 x10^3/uL
LAB-001189	Thu Nov 05, 2026 05:00 AM	platelets	209.0 x10^3/uL
LAB-001156	Fri Nov 06, 2026 05:00 AM	creatinine	0.81 mg/dL
LAB-001165	Fri Nov 06, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-001174	Fri Nov 06, 2026 05:00 AM	hemoglobin	10.78 g/dL
LAB-001190	Fri Nov 06, 2026 05:00 AM	wbc	9.23 x10^3/uL
LAB-001191	Fri Nov 06, 2026 05:00 AM	platelets	203.0 x10^3/uL
LAB-001157	Sat Nov 07, 2026 05:00 AM	creatinine	0.81 mg/dL
LAB-001166	Sat Nov 07, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001175	Sat Nov 07, 2026 05:00 AM	hemoglobin	10.78 g/dL
LAB-001192	Sat Nov 07, 2026 05:00 AM	wbc	7.98 x10^3/uL
LAB-001193	Sat Nov 07, 2026 05:00 AM	platelets	200.0 x10^3/uL

Vitals (175)

Vitals
Row	When	Kind	Value	Detail
VIT-003287	Fri Oct 30, 2026 08:29 AM	spo2	85.0	room air
VIT-003288	Fri Oct 30, 2026 08:29 AM	rr	31.0
VIT-003362	Fri Oct 30, 2026 08:29 AM	temp_c	37.0
VIT-003363	Fri Oct 30, 2026 08:29 AM	hr	76.0
VIT-003364	Fri Oct 30, 2026 08:29 AM	map	88.0
VIT-003365	Fri Oct 30, 2026 08:29 AM	gcs	15.0
VIT-003289	Fri Oct 30, 2026 08:39 AM	o2_lpm	5.0	nasal cannula
VIT-003290	Fri Oct 30, 2026 04:29 PM	spo2	91.0	nasal cannula
VIT-003291	Fri Oct 30, 2026 04:29 PM	rr	25.0
VIT-003292	Fri Oct 30, 2026 04:29 PM	o2_lpm	2.0	nasal cannula
VIT-003366	Fri Oct 30, 2026 04:29 PM	temp_c	36.7
VIT-003367	Fri Oct 30, 2026 04:29 PM	hr	89.0
VIT-003368	Fri Oct 30, 2026 04:29 PM	map	84.0
VIT-003369	Fri Oct 30, 2026 04:29 PM	gcs	15.0
VIT-003293	Sat Oct 31, 2026 12:29 AM	spo2	92.0	nasal cannula
VIT-003294	Sat Oct 31, 2026 12:29 AM	rr	22.0
VIT-003295	Sat Oct 31, 2026 12:29 AM	o2_lpm	4.0	nasal cannula
VIT-003370	Sat Oct 31, 2026 12:29 AM	temp_c	37.1
VIT-003371	Sat Oct 31, 2026 12:29 AM	hr	74.0
VIT-003372	Sat Oct 31, 2026 12:29 AM	map	77.0
VIT-003373	Sat Oct 31, 2026 12:29 AM	gcs	15.0
VIT-003296	Sat Oct 31, 2026 08:29 AM	spo2	93.0	nasal cannula
VIT-003297	Sat Oct 31, 2026 08:29 AM	rr	22.0
VIT-003298	Sat Oct 31, 2026 08:29 AM	o2_lpm	4.0	nasal cannula
VIT-003374	Sat Oct 31, 2026 08:29 AM	temp_c	36.9
VIT-003375	Sat Oct 31, 2026 08:29 AM	hr	86.0
VIT-003376	Sat Oct 31, 2026 08:29 AM	map	75.0
VIT-003377	Sat Oct 31, 2026 08:29 AM	gcs	15.0
VIT-003299	Sat Oct 31, 2026 04:29 PM	spo2	92.0	nasal cannula
VIT-003300	Sat Oct 31, 2026 04:29 PM	rr	21.0
VIT-003301	Sat Oct 31, 2026 04:29 PM	o2_lpm	2.0	nasal cannula
VIT-003378	Sat Oct 31, 2026 04:29 PM	temp_c	37.4
VIT-003379	Sat Oct 31, 2026 04:29 PM	hr	75.0
VIT-003380	Sat Oct 31, 2026 04:29 PM	map	82.0
VIT-003381	Sat Oct 31, 2026 04:29 PM	gcs	15.0
VIT-003302	Sun Nov 01, 2026 12:29 AM	spo2	94.0	nasal cannula
VIT-003303	Sun Nov 01, 2026 12:29 AM	rr	21.0
VIT-003304	Sun Nov 01, 2026 12:29 AM	o2_lpm	4.0	nasal cannula
VIT-003382	Sun Nov 01, 2026 12:29 AM	temp_c	37.2
VIT-003383	Sun Nov 01, 2026 12:29 AM	hr	82.0
VIT-003384	Sun Nov 01, 2026 12:29 AM	map	76.0
VIT-003385	Sun Nov 01, 2026 12:29 AM	gcs	15.0
VIT-003305	Sun Nov 01, 2026 08:29 AM	spo2	93.0	nasal cannula
VIT-003306	Sun Nov 01, 2026 08:29 AM	rr	21.0
VIT-003307	Sun Nov 01, 2026 08:29 AM	o2_lpm	3.0	nasal cannula
VIT-003386	Sun Nov 01, 2026 08:29 AM	temp_c	37.4
VIT-003387	Sun Nov 01, 2026 08:29 AM	hr	91.0
VIT-003388	Sun Nov 01, 2026 08:29 AM	map	78.0
VIT-003389	Sun Nov 01, 2026 08:29 AM	gcs	15.0
VIT-003308	Sun Nov 01, 2026 04:29 PM	spo2	92.0	nasal cannula
VIT-003309	Sun Nov 01, 2026 04:29 PM	rr	20.0
VIT-003310	Sun Nov 01, 2026 04:29 PM	o2_lpm	2.0	nasal cannula
VIT-003390	Sun Nov 01, 2026 04:29 PM	temp_c	36.9
VIT-003391	Sun Nov 01, 2026 04:29 PM	hr	74.0
VIT-003392	Sun Nov 01, 2026 04:29 PM	map	88.0
VIT-003393	Sun Nov 01, 2026 04:29 PM	gcs	15.0
VIT-003311	Mon Nov 02, 2026 12:29 AM	spo2	95.0	nasal cannula
VIT-003312	Mon Nov 02, 2026 12:29 AM	rr	25.0
VIT-003313	Mon Nov 02, 2026 12:29 AM	o2_lpm	4.0	nasal cannula
VIT-003394	Mon Nov 02, 2026 12:29 AM	temp_c	36.8
VIT-003395	Mon Nov 02, 2026 12:29 AM	hr	92.0
VIT-003396	Mon Nov 02, 2026 12:29 AM	map	80.0
VIT-003397	Mon Nov 02, 2026 12:29 AM	gcs	15.0
VIT-003314	Mon Nov 02, 2026 08:29 AM	spo2	95.0	nasal cannula
VIT-003315	Mon Nov 02, 2026 08:29 AM	rr	24.0
VIT-003316	Mon Nov 02, 2026 08:29 AM	o2_lpm	4.0	nasal cannula
VIT-003398	Mon Nov 02, 2026 08:29 AM	temp_c	37.5
VIT-003399	Mon Nov 02, 2026 08:29 AM	hr	77.0
VIT-003400	Mon Nov 02, 2026 08:29 AM	map	90.0
VIT-003401	Mon Nov 02, 2026 08:29 AM	gcs	15.0
VIT-003317	Mon Nov 02, 2026 04:29 PM	spo2	95.0	nasal cannula
VIT-003318	Mon Nov 02, 2026 04:29 PM	rr	26.0
VIT-003319	Mon Nov 02, 2026 04:29 PM	o2_lpm	3.0	nasal cannula
VIT-003402	Mon Nov 02, 2026 04:29 PM	temp_c	37.1
VIT-003403	Mon Nov 02, 2026 04:29 PM	hr	82.0
VIT-003404	Mon Nov 02, 2026 04:29 PM	map	89.0
VIT-003405	Mon Nov 02, 2026 04:29 PM	gcs	15.0
VIT-003320	Tue Nov 03, 2026 12:29 AM	spo2	93.0	nasal cannula
VIT-003321	Tue Nov 03, 2026 12:29 AM	rr	25.0
VIT-003322	Tue Nov 03, 2026 12:29 AM	o2_lpm	3.0	nasal cannula
VIT-003406	Tue Nov 03, 2026 12:29 AM	temp_c	37.3
VIT-003407	Tue Nov 03, 2026 12:29 AM	hr	89.0
VIT-003408	Tue Nov 03, 2026 12:29 AM	map	82.0
VIT-003409	Tue Nov 03, 2026 12:29 AM	gcs	15.0
VIT-003323	Tue Nov 03, 2026 08:29 AM	spo2	94.0	nasal cannula
VIT-003324	Tue Nov 03, 2026 08:29 AM	rr	24.0
VIT-003325	Tue Nov 03, 2026 08:29 AM	o2_lpm	2.0	nasal cannula
VIT-003410	Tue Nov 03, 2026 08:29 AM	temp_c	36.6
VIT-003411	Tue Nov 03, 2026 08:29 AM	hr	92.0
VIT-003412	Tue Nov 03, 2026 08:29 AM	map	77.0
VIT-003413	Tue Nov 03, 2026 08:29 AM	gcs	15.0
VIT-003326	Tue Nov 03, 2026 04:29 PM	spo2	94.0	nasal cannula
VIT-003327	Tue Nov 03, 2026 04:29 PM	rr	25.0
VIT-003328	Tue Nov 03, 2026 04:29 PM	o2_lpm	2.0	nasal cannula
VIT-003414	Tue Nov 03, 2026 04:29 PM	temp_c	37.5
VIT-003415	Tue Nov 03, 2026 04:29 PM	hr	83.0
VIT-003416	Tue Nov 03, 2026 04:29 PM	map	76.0
VIT-003417	Tue Nov 03, 2026 04:29 PM	gcs	15.0
VIT-003329	Wed Nov 04, 2026 12:29 AM	spo2	92.0	nasal cannula
VIT-003330	Wed Nov 04, 2026 12:29 AM	rr	22.0
VIT-003331	Wed Nov 04, 2026 12:29 AM	o2_lpm	4.0	nasal cannula
VIT-003418	Wed Nov 04, 2026 12:29 AM	temp_c	37.1
VIT-003419	Wed Nov 04, 2026 12:29 AM	hr	77.0
VIT-003420	Wed Nov 04, 2026 12:29 AM	map	77.0
VIT-003421	Wed Nov 04, 2026 12:29 AM	gcs	15.0
VIT-003332	Wed Nov 04, 2026 08:29 AM	spo2	94.0	nasal cannula
VIT-003333	Wed Nov 04, 2026 08:29 AM	rr	25.0
VIT-003334	Wed Nov 04, 2026 08:29 AM	o2_lpm	4.0	nasal cannula
VIT-003422	Wed Nov 04, 2026 08:29 AM	temp_c	37.1
VIT-003423	Wed Nov 04, 2026 08:29 AM	hr	87.0
VIT-003424	Wed Nov 04, 2026 08:29 AM	map	87.0
VIT-003425	Wed Nov 04, 2026 08:29 AM	gcs	15.0
VIT-003335	Wed Nov 04, 2026 04:29 PM	spo2	93.0	nasal cannula
VIT-003336	Wed Nov 04, 2026 04:29 PM	rr	25.0
VIT-003337	Wed Nov 04, 2026 04:29 PM	o2_lpm	4.0	nasal cannula
VIT-003426	Wed Nov 04, 2026 04:29 PM	temp_c	37.3
VIT-003427	Wed Nov 04, 2026 04:29 PM	hr	81.0
VIT-003428	Wed Nov 04, 2026 04:29 PM	map	91.0
VIT-003429	Wed Nov 04, 2026 04:29 PM	gcs	15.0
VIT-003338	Thu Nov 05, 2026 12:29 AM	spo2	91.0	nasal cannula
VIT-003339	Thu Nov 05, 2026 12:29 AM	rr	21.0
VIT-003340	Thu Nov 05, 2026 12:29 AM	o2_lpm	3.0	nasal cannula
VIT-003430	Thu Nov 05, 2026 12:29 AM	temp_c	36.8
VIT-003431	Thu Nov 05, 2026 12:29 AM	hr	68.0
VIT-003432	Thu Nov 05, 2026 12:29 AM	map	74.0
VIT-003433	Thu Nov 05, 2026 12:29 AM	gcs	15.0
VIT-003341	Thu Nov 05, 2026 08:29 AM	spo2	94.0	nasal cannula
VIT-003342	Thu Nov 05, 2026 08:29 AM	rr	26.0
VIT-003343	Thu Nov 05, 2026 08:29 AM	o2_lpm	4.0	nasal cannula
VIT-003434	Thu Nov 05, 2026 08:29 AM	temp_c	37.3
VIT-003435	Thu Nov 05, 2026 08:29 AM	hr	74.0
VIT-003436	Thu Nov 05, 2026 08:29 AM	map	92.0
VIT-003437	Thu Nov 05, 2026 08:29 AM	gcs	15.0
VIT-003344	Thu Nov 05, 2026 04:29 PM	spo2	95.0	nasal cannula
VIT-003345	Thu Nov 05, 2026 04:29 PM	rr	20.0
VIT-003346	Thu Nov 05, 2026 04:29 PM	o2_lpm	3.0	nasal cannula
VIT-003438	Thu Nov 05, 2026 04:29 PM	temp_c	37.6
VIT-003439	Thu Nov 05, 2026 04:29 PM	hr	78.0
VIT-003440	Thu Nov 05, 2026 04:29 PM	map	75.0
VIT-003441	Thu Nov 05, 2026 04:29 PM	gcs	15.0
VIT-003347	Fri Nov 06, 2026 12:29 AM	spo2	95.0	nasal cannula
VIT-003348	Fri Nov 06, 2026 12:29 AM	rr	24.0
VIT-003349	Fri Nov 06, 2026 12:29 AM	o2_lpm	2.0	nasal cannula
VIT-003442	Fri Nov 06, 2026 12:29 AM	temp_c	37.0
VIT-003443	Fri Nov 06, 2026 12:29 AM	hr	78.0
VIT-003444	Fri Nov 06, 2026 12:29 AM	map	76.0
VIT-003445	Fri Nov 06, 2026 12:29 AM	gcs	15.0
VIT-003350	Fri Nov 06, 2026 08:29 AM	spo2	94.0	nasal cannula
VIT-003351	Fri Nov 06, 2026 08:29 AM	rr	20.0
VIT-003352	Fri Nov 06, 2026 08:29 AM	o2_lpm	4.0	nasal cannula
VIT-003446	Fri Nov 06, 2026 08:29 AM	temp_c	36.6
VIT-003447	Fri Nov 06, 2026 08:29 AM	hr	89.0
VIT-003448	Fri Nov 06, 2026 08:29 AM	map	82.0
VIT-003449	Fri Nov 06, 2026 08:29 AM	gcs	15.0
VIT-003353	Fri Nov 06, 2026 04:29 PM	spo2	92.0	nasal cannula
VIT-003354	Fri Nov 06, 2026 04:29 PM	rr	21.0
VIT-003355	Fri Nov 06, 2026 04:29 PM	o2_lpm	3.0	nasal cannula
VIT-003450	Fri Nov 06, 2026 04:29 PM	temp_c	36.7
VIT-003451	Fri Nov 06, 2026 04:29 PM	hr	69.0
VIT-003452	Fri Nov 06, 2026 04:29 PM	map	78.0
VIT-003453	Fri Nov 06, 2026 04:29 PM	gcs	15.0
VIT-003356	Sat Nov 07, 2026 12:29 AM	spo2	95.0	nasal cannula
VIT-003357	Sat Nov 07, 2026 12:29 AM	rr	23.0
VIT-003358	Sat Nov 07, 2026 12:29 AM	o2_lpm	3.0	nasal cannula
VIT-003454	Sat Nov 07, 2026 12:29 AM	temp_c	37.5
VIT-003455	Sat Nov 07, 2026 12:29 AM	hr	85.0
VIT-003456	Sat Nov 07, 2026 12:29 AM	map	82.0
VIT-003457	Sat Nov 07, 2026 12:29 AM	gcs	15.0
VIT-003359	Sat Nov 07, 2026 08:29 AM	spo2	91.0	nasal cannula
VIT-003360	Sat Nov 07, 2026 08:29 AM	rr	25.0
VIT-003361	Sat Nov 07, 2026 08:29 AM	o2_lpm	2.0	nasal cannula
VIT-003458	Sat Nov 07, 2026 08:29 AM	temp_c	36.7
VIT-003459	Sat Nov 07, 2026 08:29 AM	hr	88.0
VIT-003460	Sat Nov 07, 2026 08:29 AM	map	85.0
VIT-003461	Sat Nov 07, 2026 08:29 AM	gcs	15.0

Medications, orders, echo, history (1)

ORD-000028 10-31 09:00 transfusion_prbc: transfuse PRBC

Notes

History and physical · DOC-000114 · Dr. Camila Oyelaran (resident) · Fri Oct 30, 2026 11:09 AM

Cited facts from this note (2)

bleeding_source: coffee-ground emesis · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… vice: Hospital Medicine Attending: Dr. Gideon Zeller History of present illness: 48-year-old woman admitted with upper GI bleed. Presented after two days of coffee-ground emesis; GI consulted for endoscopy. Past medical history: hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessor …
work_of_breathing: increased · cited p. 1, line 8 · confidence 0.90

Show source for work_of_breathing

… ed after two days of coffee-ground emesis; GI consulted for endoscopy. Past medical history: hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessory muscle use. Assessment and plan: 1. Upper GI bleed: PPI, GI following.

Source document DOC-000114: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Zara Brightwater   MRN: MRN78659479   Admitted: 2026-10-30 08:09
Service: Hospital Medicine   Attending: Dr. Gideon Zeller

History of present illness: 48-year-old woman admitted with upper GI bleed. Presented after two days of coffee-ground emesis; GI consulted for endoscopy.
Past medical history: hyperlipidemia.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscle use.
Assessment and plan:
1. Upper GI bleed: PPI, GI following.

Progress note · DOC-000115 · Dr. Camila Oyelaran (resident) · Sun Nov 01, 2026 08:09 AM

Source document DOC-000115: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Zara Brightwater   MRN: MRN78659479   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Upper GI bleed: continue current management.
2. Acute kidney injury: trend creatinine, hold nephrotoxins, strict intake and output.
3. Acute hypoxic respiratory failure: supplemental oxygen, wean as tolerated.
4. Acute blood loss anemia: trend hemoglobin, transfuse if needed.

Resident: Dr. Camila Oyelaran   Attending cosign: completed

Discharge summary · DOC-000116 · Dr. Gideon Zeller (attending) · Sat Nov 07, 2026 01:31 PM

Source document DOC-000116: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Zara Brightwater   MRN: MRN78659479
Admitted 2026-10-30; discharged 2026-11-07.

Discharge diagnoses:
- upper GI bleed
- acute kidney injury
- acute hypoxic respiratory failure
- acute blood loss anemia
- hyperlipidemia

Disposition: home with follow-up.