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-00037: Amara Yardley

84M · MRN37795591 · Hospital Medicine · admitted Mon Nov 02, 2026 05:35 PM · discharged Sun Nov 08, 2026 12:51 PM · attending Dr. Cyrus Ellingham · resident Dr. Camila Oyelaran · 167 cm, 53.4 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“malnutrition” · E46 Unspecified protein-calorie malnutrition
“congestive heart failure” · I50.9 Heart failure, unspecified

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 met

Specificity gap

Criteria support Acute kidney injury (KDIGO stage 2) (N17.9); no corresponding diagnosis is documented.

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=2.266, t.ratio_s1=1.5, creat_rise_48h=0.54, 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=2.266, t.ratio_s3=3.0, creat_peak=2.47, 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=2.266, 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=False, stage2=True, meets_definition=True	2
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.54, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=2, baseline_independent=True	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=14.79, 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=0.5, 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=0.5, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=14.79, 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=225, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=70.0, egfr_late=66.9	70.0
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=70.0, t.g2=60, egfr_late=66.9	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=70.0, 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=70.0, egfr_late=66.9, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=70.0, t.g2=60	true

Heart failure

Clinical judgement required

Clinical judgement required: 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=45.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	false
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=True, np_elevated=False, new_o2=False	1
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=30.0, t.ref=40, t.pres=50	systolic
derived: improved	`coalesce(lvef_prior_min <= t.ref and lvef > t.ref and lvef - lvef_prior_min >= t.improved_rise, false)`	lvef_prior_min=unknown, t.ref=40, lvef=30.0, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=1, hf_history=True	unknown
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=systolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=unknown	unknown
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=systolic, acuity=unknown	unknown
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=systolic, acuity=unknown	unknown
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=unknown	false
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=systolic, acuity=unknown	false
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=systolic, acuity=unknown	false
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

Criteria met

Specificity gap

Documented “malnutrition” (E46); criteria support the more specific Severe protein-calorie malnutrition (chronic illness context) (E43).

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=50.0, t.a_sev_intake_pct=50, intake_days=52.0, t.a_sev_intake_days=5	true
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=50.0, t.a_mod_intake_pct=75, intake_days=52.0, 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=180.0, wt_loss_pct=12.1	false
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=180.0, wt_loss_pct=12.1	false
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=50.0, t.c_intake_pct=75, intake_days=52.0, t.c_intake_days=30	true
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=50.0, t.c_intake_pct=75, intake_days=52.0, t.c_intake_days=30	true
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=180.0, wt_loss_pct=12.1	true
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=180.0, wt_loss_pct=12.1	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=50.0, wt_loss_pct=12.1, fat_loss=3, muscle_loss=2, fluid=0, grip_reduced=unknown	5
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=chronic, a_sev_intake=True, a_sev_wt=False, fat_loss=3, muscle_loss=2, fluid=0, grip_reduced=unknown, c_sev_intake=True, c_sev_wt=True	3
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=chronic, a_sev_intake=True, a_mod_intake=True, a_sev_wt=False, a_mod_wt=False, fat_loss=3, muscle_loss=2, fluid=0, grip_reduced=unknown, c_sev_intake=True, c_mod_intake=True, c_sev_wt=True, c_mod_wt=True	4
outcome: severe	`n_severe >= 2`	n_severe=3	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=84, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=19.1, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=19.1, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=19.1, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=19.1, 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=19.0, 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 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=36.9, 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=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=10.65, t.wbc_hi=12, wbc_min_48h=6.8, 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=185.0	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=0.74	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=2.47	2
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=1.09	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=2, 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=0, 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 (39)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001252	Thu Nov 27, 2025 09:15 AM	creatinine	1.05 mg/dL
LAB-001253	Sat Jul 11, 2026 10:05 AM	creatinine	1.09 mg/dL
LAB-001254	Mon Nov 02, 2026 06:35 PM	creatinine	1.93 mg/dL
LAB-001261	Mon Nov 02, 2026 06:35 PM	bnp	45.0 pg/mL
LAB-001262	Mon Nov 02, 2026 06:35 PM	sodium	141.0 mmol/L
LAB-001269	Mon Nov 02, 2026 06:35 PM	hemoglobin	15.09 g/dL
LAB-001276	Mon Nov 02, 2026 06:35 PM	wbc	10.47 x10^3/uL
LAB-001277	Mon Nov 02, 2026 06:35 PM	platelets	185.0 x10^3/uL
LAB-001290	Mon Nov 02, 2026 06:35 PM	bilirubin	0.74 mg/dL
LAB-001255	Tue Nov 03, 2026 05:00 AM	creatinine	2.47 mg/dL
LAB-001263	Tue Nov 03, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-001270	Tue Nov 03, 2026 05:00 AM	hemoglobin	15.19 g/dL
LAB-001278	Tue Nov 03, 2026 05:00 AM	wbc	6.8 x10^3/uL
LAB-001279	Tue Nov 03, 2026 05:00 AM	platelets	297.0 x10^3/uL
LAB-001256	Wed Nov 04, 2026 05:00 AM	creatinine	2.22 mg/dL
LAB-001264	Wed Nov 04, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001271	Wed Nov 04, 2026 05:00 AM	hemoglobin	15.23 g/dL
LAB-001280	Wed Nov 04, 2026 05:00 AM	wbc	10.65 x10^3/uL
LAB-001281	Wed Nov 04, 2026 05:00 AM	platelets	254.0 x10^3/uL
LAB-001257	Thu Nov 05, 2026 05:00 AM	creatinine	1.85 mg/dL
LAB-001265	Thu Nov 05, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-001272	Thu Nov 05, 2026 05:00 AM	hemoglobin	15.26 g/dL
LAB-001282	Thu Nov 05, 2026 05:00 AM	wbc	10.75 x10^3/uL
LAB-001283	Thu Nov 05, 2026 05:00 AM	platelets	215.0 x10^3/uL
LAB-001258	Fri Nov 06, 2026 05:00 AM	creatinine	1.53 mg/dL
LAB-001266	Fri Nov 06, 2026 05:00 AM	sodium	141.0 mmol/L
LAB-001273	Fri Nov 06, 2026 05:00 AM	hemoglobin	15.02 g/dL
LAB-001284	Fri Nov 06, 2026 05:00 AM	wbc	8.0 x10^3/uL
LAB-001285	Fri Nov 06, 2026 05:00 AM	platelets	250.0 x10^3/uL
LAB-001259	Sat Nov 07, 2026 05:00 AM	creatinine	1.36 mg/dL
LAB-001267	Sat Nov 07, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-001274	Sat Nov 07, 2026 05:00 AM	hemoglobin	14.79 g/dL
LAB-001286	Sat Nov 07, 2026 05:00 AM	wbc	8.15 x10^3/uL
LAB-001287	Sat Nov 07, 2026 05:00 AM	platelets	175.0 x10^3/uL
LAB-001260	Sun Nov 08, 2026 05:00 AM	creatinine	1.23 mg/dL
LAB-001268	Sun Nov 08, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001275	Sun Nov 08, 2026 05:00 AM	hemoglobin	15.21 g/dL
LAB-001288	Sun Nov 08, 2026 05:00 AM	wbc	8.29 x10^3/uL
LAB-001289	Sun Nov 08, 2026 05:00 AM	platelets	290.0 x10^3/uL

Vitals (108)

Vitals
Row	When	Kind	Value	Detail
VIT-003612	Mon Nov 02, 2026 05:55 PM	spo2	96.0	room air
VIT-003613	Mon Nov 02, 2026 05:55 PM	rr	15.0
VIT-003648	Mon Nov 02, 2026 05:55 PM	temp_c	37.2
VIT-003649	Mon Nov 02, 2026 05:55 PM	hr	76.0
VIT-003650	Mon Nov 02, 2026 05:55 PM	map	75.0
VIT-003651	Mon Nov 02, 2026 05:55 PM	gcs	15.0
VIT-003614	Tue Nov 03, 2026 01:55 AM	spo2	96.0	room air
VIT-003615	Tue Nov 03, 2026 01:55 AM	rr	17.0
VIT-003652	Tue Nov 03, 2026 01:55 AM	temp_c	37.1
VIT-003653	Tue Nov 03, 2026 01:55 AM	hr	72.0
VIT-003654	Tue Nov 03, 2026 01:55 AM	map	76.0
VIT-003655	Tue Nov 03, 2026 01:55 AM	gcs	15.0
VIT-003616	Tue Nov 03, 2026 09:55 AM	spo2	97.0	room air
VIT-003617	Tue Nov 03, 2026 09:55 AM	rr	18.0
VIT-003656	Tue Nov 03, 2026 09:55 AM	temp_c	37.1
VIT-003657	Tue Nov 03, 2026 09:55 AM	hr	87.0
VIT-003658	Tue Nov 03, 2026 09:55 AM	map	83.0
VIT-003659	Tue Nov 03, 2026 09:55 AM	gcs	15.0
VIT-003618	Tue Nov 03, 2026 05:55 PM	spo2	98.0	room air
VIT-003619	Tue Nov 03, 2026 05:55 PM	rr	17.0
VIT-003660	Tue Nov 03, 2026 05:55 PM	temp_c	36.9
VIT-003661	Tue Nov 03, 2026 05:55 PM	hr	84.0
VIT-003662	Tue Nov 03, 2026 05:55 PM	map	75.0
VIT-003663	Tue Nov 03, 2026 05:55 PM	gcs	15.0
VIT-003620	Wed Nov 04, 2026 01:55 AM	spo2	95.0	room air
VIT-003621	Wed Nov 04, 2026 01:55 AM	rr	19.0
VIT-003664	Wed Nov 04, 2026 01:55 AM	temp_c	37.6
VIT-003665	Wed Nov 04, 2026 01:55 AM	hr	82.0
VIT-003666	Wed Nov 04, 2026 01:55 AM	map	87.0
VIT-003667	Wed Nov 04, 2026 01:55 AM	gcs	15.0
VIT-003622	Wed Nov 04, 2026 09:55 AM	spo2	96.0	room air
VIT-003623	Wed Nov 04, 2026 09:55 AM	rr	16.0
VIT-003668	Wed Nov 04, 2026 09:55 AM	temp_c	37.1
VIT-003669	Wed Nov 04, 2026 09:55 AM	hr	71.0
VIT-003670	Wed Nov 04, 2026 09:55 AM	map	82.0
VIT-003671	Wed Nov 04, 2026 09:55 AM	gcs	15.0
VIT-003624	Wed Nov 04, 2026 05:55 PM	spo2	99.0	room air
VIT-003625	Wed Nov 04, 2026 05:55 PM	rr	19.0
VIT-003672	Wed Nov 04, 2026 05:55 PM	temp_c	37.4
VIT-003673	Wed Nov 04, 2026 05:55 PM	hr	77.0
VIT-003674	Wed Nov 04, 2026 05:55 PM	map	79.0
VIT-003675	Wed Nov 04, 2026 05:55 PM	gcs	15.0
VIT-003626	Thu Nov 05, 2026 01:55 AM	spo2	95.0	room air
VIT-003627	Thu Nov 05, 2026 01:55 AM	rr	15.0
VIT-003676	Thu Nov 05, 2026 01:55 AM	temp_c	37.2
VIT-003677	Thu Nov 05, 2026 01:55 AM	hr	89.0
VIT-003678	Thu Nov 05, 2026 01:55 AM	map	89.0
VIT-003679	Thu Nov 05, 2026 01:55 AM	gcs	15.0
VIT-003628	Thu Nov 05, 2026 09:55 AM	spo2	98.0	room air
VIT-003629	Thu Nov 05, 2026 09:55 AM	rr	15.0
VIT-003680	Thu Nov 05, 2026 09:55 AM	temp_c	37.5
VIT-003681	Thu Nov 05, 2026 09:55 AM	hr	81.0
VIT-003682	Thu Nov 05, 2026 09:55 AM	map	77.0
VIT-003683	Thu Nov 05, 2026 09:55 AM	gcs	15.0
VIT-003630	Thu Nov 05, 2026 05:55 PM	spo2	94.0	room air
VIT-003631	Thu Nov 05, 2026 05:55 PM	rr	18.0
VIT-003684	Thu Nov 05, 2026 05:55 PM	temp_c	36.8
VIT-003685	Thu Nov 05, 2026 05:55 PM	hr	81.0
VIT-003686	Thu Nov 05, 2026 05:55 PM	map	79.0
VIT-003687	Thu Nov 05, 2026 05:55 PM	gcs	15.0
VIT-003632	Fri Nov 06, 2026 01:55 AM	spo2	99.0	room air
VIT-003633	Fri Nov 06, 2026 01:55 AM	rr	15.0
VIT-003688	Fri Nov 06, 2026 01:55 AM	temp_c	36.8
VIT-003689	Fri Nov 06, 2026 01:55 AM	hr	72.0
VIT-003690	Fri Nov 06, 2026 01:55 AM	map	83.0
VIT-003691	Fri Nov 06, 2026 01:55 AM	gcs	15.0
VIT-003634	Fri Nov 06, 2026 09:55 AM	spo2	97.0	room air
VIT-003635	Fri Nov 06, 2026 09:55 AM	rr	19.0
VIT-003692	Fri Nov 06, 2026 09:55 AM	temp_c	37.5
VIT-003693	Fri Nov 06, 2026 09:55 AM	hr	83.0
VIT-003694	Fri Nov 06, 2026 09:55 AM	map	80.0
VIT-003695	Fri Nov 06, 2026 09:55 AM	gcs	15.0
VIT-003636	Fri Nov 06, 2026 05:55 PM	spo2	98.0	room air
VIT-003637	Fri Nov 06, 2026 05:55 PM	rr	14.0
VIT-003696	Fri Nov 06, 2026 05:55 PM	temp_c	36.7
VIT-003697	Fri Nov 06, 2026 05:55 PM	hr	80.0
VIT-003698	Fri Nov 06, 2026 05:55 PM	map	83.0
VIT-003699	Fri Nov 06, 2026 05:55 PM	gcs	15.0
VIT-003638	Sat Nov 07, 2026 01:55 AM	spo2	94.0	room air
VIT-003639	Sat Nov 07, 2026 01:55 AM	rr	16.0
VIT-003700	Sat Nov 07, 2026 01:55 AM	temp_c	36.8
VIT-003701	Sat Nov 07, 2026 01:55 AM	hr	92.0
VIT-003702	Sat Nov 07, 2026 01:55 AM	map	81.0
VIT-003703	Sat Nov 07, 2026 01:55 AM	gcs	15.0
VIT-003640	Sat Nov 07, 2026 09:55 AM	spo2	94.0	room air
VIT-003641	Sat Nov 07, 2026 09:55 AM	rr	14.0
VIT-003704	Sat Nov 07, 2026 09:55 AM	temp_c	37.2
VIT-003705	Sat Nov 07, 2026 09:55 AM	hr	84.0
VIT-003706	Sat Nov 07, 2026 09:55 AM	map	80.0
VIT-003707	Sat Nov 07, 2026 09:55 AM	gcs	15.0
VIT-003642	Sat Nov 07, 2026 05:55 PM	spo2	98.0	room air
VIT-003643	Sat Nov 07, 2026 05:55 PM	rr	14.0
VIT-003708	Sat Nov 07, 2026 05:55 PM	temp_c	37.0
VIT-003709	Sat Nov 07, 2026 05:55 PM	hr	72.0
VIT-003710	Sat Nov 07, 2026 05:55 PM	map	75.0
VIT-003711	Sat Nov 07, 2026 05:55 PM	gcs	15.0
VIT-003644	Sun Nov 08, 2026 01:55 AM	spo2	96.0	room air
VIT-003645	Sun Nov 08, 2026 01:55 AM	rr	19.0
VIT-003712	Sun Nov 08, 2026 01:55 AM	temp_c	36.6
VIT-003713	Sun Nov 08, 2026 01:55 AM	hr	85.0
VIT-003714	Sun Nov 08, 2026 01:55 AM	map	75.0
VIT-003715	Sun Nov 08, 2026 01:55 AM	gcs	15.0
VIT-003646	Sun Nov 08, 2026 09:55 AM	spo2	96.0	room air
VIT-003647	Sun Nov 08, 2026 09:55 AM	rr	19.0
VIT-003716	Sun Nov 08, 2026 09:55 AM	temp_c	37.0
VIT-003717	Sun Nov 08, 2026 09:55 AM	hr	71.0
VIT-003718	Sun Nov 08, 2026 09:55 AM	map	77.0
VIT-003719	Sun Nov 08, 2026 09:55 AM	gcs	15.0

Medications, orders, echo, history (7)

MED-000131 11-02 18:35 ceftriaxone per protocol IV
MED-000132 11-03 05:00 piperacillin-tazobactam per protocol IV
MED-000133 11-04 05:00 piperacillin-tazobactam per protocol IV
MED-000134 11-02 20:35 furosemide 40 mg IV
ORD-000031 11-02 18:05 blood_culture: blood cultures x2
ECH-000015 2026-11-03 echo LVEF 30.0%
HX-000011 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000123 · Dr. Camila Oyelaran (resident) · Mon Nov 02, 2026 08:35 PM

Cited facts from this note (1)

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: 84-year-old man admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: heart failure with reduced ejection fraction. Review of systems otherwise negative. Exam: …

Source document DOC-000123: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Amara Yardley   MRN: MRN37795591   Admitted: 2026-11-02 17:35
Service: Hospital Medicine   Attending: Dr. Cyrus Ellingham

History of present illness: 84-year-old man admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: heart failure with reduced ejection fraction.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.

Nutrition assessment · DOC-000122 · Viggo Ravensworth, RD (dietitian) · Tue Nov 03, 2026 10:35 PM

Cited facts from this note (8)

fat_loss: severe · cited p. 1, line 7 · confidence 0.90

Show source for fat_loss

… xt: chronic illness Intake: estimated energy intake 50% of needs for 52 days. Weight history: 12.1% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… needs for 52 days. Weight history: 12.1% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
intake_days: 52 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Amara Yardley MRN: MRN37795591 Context: chronic illness Intake: estimated energy intake 50% of needs for 52 days. Weight history: 12.1% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulat …
intake_pct: 50 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Amara Yardley MRN: MRN37795591 Context: chronic illness Intake: estimated energy intake 50% of needs for 52 days. Weight history: 12.1% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulat …
muscle_loss: moderate · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… ated energy intake 50% of needs for 52 days. Weight history: 12.1% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
nutrition_context: chronic · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Amara Yardley MRN: MRN37795591 Context: chronic illness Intake: estimated energy intake 50% of needs for 52 days. Weight history: 12.1% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subc …
weight_loss_days: 180 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… stered Dietitian) Patient: Amara Yardley MRN: MRN37795591 Context: chronic illness Intake: estimated energy intake 50% of needs for 52 days. Weight history: 12.1% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplemen …
weight_loss_pct: 12.1 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… stered Dietitian) Patient: Amara Yardley MRN: MRN37795591 Context: chronic illness Intake: estimated energy intake 50% of needs for 52 days. Weight history: 12.1% weight loss over 180 days. Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplemen …

Source document DOC-000122: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Amara Yardley   MRN: MRN37795591

Context: chronic illness
Intake: estimated energy intake 50% of needs for 52 days.
Weight history: 12.1% weight loss over 180 days.
Nutrition-focused physical exam: severe loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation.
Recommendations: high-protein oral supplement; calorie counts; weekly weights.

Progress note · DOC-000124 · Dr. Camila Oyelaran (resident) · Wed Nov 04, 2026 06:35 PM

Source document DOC-000124: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Amara Yardley   MRN: MRN37795591   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. Congestive heart failure: diuresis and daily weights; monitor electrolytes.

Resident: Dr. Camila Oyelaran   Attending cosign: completed

Discharge summary · DOC-000125 · Dr. Cyrus Ellingham (attending) · Sun Nov 08, 2026 12:51 PM

Source document DOC-000125: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Amara Yardley   MRN: MRN37795591
Admitted 2026-11-02; discharged 2026-11-08.

Discharge diagnoses:
- community-acquired pneumonia
- malnutrition
- congestive heart failure

Disposition: home with follow-up.