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-00040: Nadia Larkspur

83F · MRN30417491 · Cardiology · admitted Thu Nov 05, 2026 09:07 PM · discharged Sun Nov 08, 2026 04:09 PM · attending Dr. Isaac Abernath · resident Dr. Priya Thorne · 159 cm, 50.1 kg

Documented diagnoses (current)

“moderate protein-calorie malnutrition” · E44.0 Moderate protein-calorie malnutrition
“acute renal insufficiency” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
Principal: “CHF” · I50.9 Heart failure, unspecified
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“hypertension” · I10 Essential (primary) hypertension
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 292 Heart failure and shock with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 292.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

Specificity gap

Documented “acute renal insufficiency” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 1) (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=1.88, t.ratio_s1=1.5, creat_rise_48h=0.21, 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=1.88, t.ratio_s3=3.0, creat_peak=0.94, 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=1.88, 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=0.21, 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 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=13.06, 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=13.06, 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=166, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=93.5, egfr_late=93.0	93.5
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=93.5, t.g2=60, egfr_late=93.0	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=93.5, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=False, egfr_early=93.5, egfr_late=93.0, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=93.5, 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=54.0, 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=63.0, t.ref=40, t.pres=50	diastolic
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=63.0, 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=False	unknown
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=diastolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=unknown	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=diastolic, acuity=unknown	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=unknown	false
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=unknown	unknown
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=diastolic, acuity=unknown	unknown
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=diastolic, 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

Criteria met

No gap

Supported as documented (E44.0).

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=70.0, t.a_sev_intake_pct=50, intake_days=14.0, 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=70.0, t.a_mod_intake_pct=75, intake_days=14.0, 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=30.0, wt_loss_pct=5.4	true
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=30.0, wt_loss_pct=5.4	true
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=70.0, t.c_intake_pct=75, intake_days=14.0, 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=70.0, t.c_intake_pct=75, intake_days=14.0, 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=30.0, wt_loss_pct=5.4	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=30.0, wt_loss_pct=5.4	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=70.0, wt_loss_pct=5.4, fat_loss=1, muscle_loss=1, 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=acute, a_sev_intake=False, a_sev_wt=True, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=True	1
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=True, a_mod_wt=True, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=True, c_mod_wt=True	4
outcome: severe	`n_severe >= 2`	n_severe=1	false
outcome: moderate	`n_moderate >= 2`	n_moderate=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=83, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=19.8, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=19.8, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=19.8, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=19.8, t.c1=30	true

Pressure injury

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule pressure_injury v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sacral	`wound_site == 'sacral'`	wound_site=unknown	unknown
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=unknown	true

Acute respiratory failure

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule respiratory_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: measured	`present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min)`	spo2_min_ra=94.0, pao2_min_ra=unknown, pf_min=unknown	true
derived: hypoxemia	`coalesce(spo2_min_ra < t.spo2_ra, false) or coalesce(pao2_min_ra < t.pao2, false) or coalesce(pf_min < t.pf, false)`	spo2_min_ra=94.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	false
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=20.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=False	false
outcome: met	`hypoxemia and distress`	hypoxemia=False, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=False	false
outcome: not_met	`measured and not hypoxemia and o2_max_lpm <= t.o2_low and not adv_resp_support`	measured=True, hypoxemia=False, o2_max_lpm=0.0, t.o2_low=2, adv_resp_support=False	true

Sepsis

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=37.5, t.t_hi=38, temp_min_48h=37.0, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=82.0, 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=10.03, t.wbc_hi=12, wbc_min_48h=9.92, 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=172.0	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=0.87	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=0.94	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=0.5	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=0, sofa_renal_baseline=0	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, sirs_count=0, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=False, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=False	true

Structured data

Labs (24)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001369	Mon Jan 26, 2026 09:15 AM	creatinine	0.49 mg/dL
LAB-001370	Sun Jul 12, 2026 10:05 AM	creatinine	0.5 mg/dL
LAB-001371	Thu Nov 05, 2026 10:07 PM	creatinine	0.73 mg/dL
LAB-001375	Thu Nov 05, 2026 10:07 PM	bnp	54.0 pg/mL
LAB-001376	Thu Nov 05, 2026 10:07 PM	sodium	136.0 mmol/L
LAB-001380	Thu Nov 05, 2026 10:07 PM	hemoglobin	13.09 g/dL
LAB-001384	Thu Nov 05, 2026 10:07 PM	wbc	9.98 x10^3/uL
LAB-001385	Thu Nov 05, 2026 10:07 PM	platelets	277.0 x10^3/uL
LAB-001392	Thu Nov 05, 2026 10:07 PM	bilirubin	0.87 mg/dL
LAB-001372	Fri Nov 06, 2026 05:00 AM	creatinine	0.94 mg/dL
LAB-001377	Fri Nov 06, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001381	Fri Nov 06, 2026 05:00 AM	hemoglobin	13.06 g/dL
LAB-001386	Fri Nov 06, 2026 05:00 AM	wbc	9.92 x10^3/uL
LAB-001387	Fri Nov 06, 2026 05:00 AM	platelets	172.0 x10^3/uL
LAB-001373	Sat Nov 07, 2026 05:00 AM	creatinine	0.84 mg/dL
LAB-001378	Sat Nov 07, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001382	Sat Nov 07, 2026 05:00 AM	hemoglobin	13.1 g/dL
LAB-001388	Sat Nov 07, 2026 05:00 AM	wbc	10.03 x10^3/uL
LAB-001389	Sat Nov 07, 2026 05:00 AM	platelets	173.0 x10^3/uL
LAB-001374	Sun Nov 08, 2026 05:00 AM	creatinine	0.7 mg/dL
LAB-001379	Sun Nov 08, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-001383	Sun Nov 08, 2026 05:00 AM	hemoglobin	13.16 g/dL
LAB-001390	Sun Nov 08, 2026 05:00 AM	wbc	7.54 x10^3/uL
LAB-001391	Sun Nov 08, 2026 05:00 AM	platelets	268.0 x10^3/uL

Vitals (54)

Vitals
Row	When	Kind	Value	Detail
VIT-003936	Thu Nov 05, 2026 09:27 PM	spo2	96.0	room air
VIT-003937	Thu Nov 05, 2026 09:27 PM	rr	14.0
VIT-003954	Thu Nov 05, 2026 09:27 PM	temp_c	37.4
VIT-003955	Thu Nov 05, 2026 09:27 PM	hr	70.0
VIT-003956	Thu Nov 05, 2026 09:27 PM	map	75.0
VIT-003957	Thu Nov 05, 2026 09:27 PM	gcs	15.0
VIT-003938	Fri Nov 06, 2026 05:27 AM	spo2	94.0	room air
VIT-003939	Fri Nov 06, 2026 05:27 AM	rr	19.0
VIT-003958	Fri Nov 06, 2026 05:27 AM	temp_c	37.5
VIT-003959	Fri Nov 06, 2026 05:27 AM	hr	74.0
VIT-003960	Fri Nov 06, 2026 05:27 AM	map	82.0
VIT-003961	Fri Nov 06, 2026 05:27 AM	gcs	15.0
VIT-003940	Fri Nov 06, 2026 01:27 PM	spo2	96.0	room air
VIT-003941	Fri Nov 06, 2026 01:27 PM	rr	17.0
VIT-003962	Fri Nov 06, 2026 01:27 PM	temp_c	37.5
VIT-003963	Fri Nov 06, 2026 01:27 PM	hr	78.0
VIT-003964	Fri Nov 06, 2026 01:27 PM	map	78.0
VIT-003965	Fri Nov 06, 2026 01:27 PM	gcs	15.0
VIT-003942	Fri Nov 06, 2026 09:27 PM	spo2	96.0	room air
VIT-003943	Fri Nov 06, 2026 09:27 PM	rr	18.0
VIT-003966	Fri Nov 06, 2026 09:27 PM	temp_c	37.0
VIT-003967	Fri Nov 06, 2026 09:27 PM	hr	80.0
VIT-003968	Fri Nov 06, 2026 09:27 PM	map	75.0
VIT-003969	Fri Nov 06, 2026 09:27 PM	gcs	15.0
VIT-003944	Sat Nov 07, 2026 05:27 AM	spo2	94.0	room air
VIT-003945	Sat Nov 07, 2026 05:27 AM	rr	18.0
VIT-003970	Sat Nov 07, 2026 05:27 AM	temp_c	37.2
VIT-003971	Sat Nov 07, 2026 05:27 AM	hr	82.0
VIT-003972	Sat Nov 07, 2026 05:27 AM	map	86.0
VIT-003973	Sat Nov 07, 2026 05:27 AM	gcs	15.0
VIT-003946	Sat Nov 07, 2026 01:27 PM	spo2	94.0	room air
VIT-003947	Sat Nov 07, 2026 01:27 PM	rr	17.0
VIT-003974	Sat Nov 07, 2026 01:27 PM	temp_c	37.0
VIT-003975	Sat Nov 07, 2026 01:27 PM	hr	71.0
VIT-003976	Sat Nov 07, 2026 01:27 PM	map	85.0
VIT-003977	Sat Nov 07, 2026 01:27 PM	gcs	15.0
VIT-003948	Sat Nov 07, 2026 09:27 PM	spo2	95.0	room air
VIT-003949	Sat Nov 07, 2026 09:27 PM	rr	19.0
VIT-003978	Sat Nov 07, 2026 09:27 PM	temp_c	36.6
VIT-003979	Sat Nov 07, 2026 09:27 PM	hr	87.0
VIT-003980	Sat Nov 07, 2026 09:27 PM	map	90.0
VIT-003981	Sat Nov 07, 2026 09:27 PM	gcs	15.0
VIT-003950	Sun Nov 08, 2026 05:27 AM	spo2	94.0	room air
VIT-003951	Sun Nov 08, 2026 05:27 AM	rr	20.0
VIT-003982	Sun Nov 08, 2026 05:27 AM	temp_c	36.6
VIT-003983	Sun Nov 08, 2026 05:27 AM	hr	90.0
VIT-003984	Sun Nov 08, 2026 05:27 AM	map	86.0
VIT-003985	Sun Nov 08, 2026 05:27 AM	gcs	15.0
VIT-003952	Sun Nov 08, 2026 01:27 PM	spo2	96.0	room air
VIT-003953	Sun Nov 08, 2026 01:27 PM	rr	14.0
VIT-003986	Sun Nov 08, 2026 01:27 PM	temp_c	37.1
VIT-003987	Sun Nov 08, 2026 01:27 PM	hr	79.0
VIT-003988	Sun Nov 08, 2026 01:27 PM	map	89.0
VIT-003989	Sun Nov 08, 2026 01:27 PM	gcs	15.0

Medications, orders, echo, history (2)

MED-000147 11-06 00:07 furosemide 40 mg IV
ECH-000018 2026-11-07 echo LVEF 63.0%

Notes

History and physical · DOC-000134 · Dr. Priya Thorne (resident) · Fri Nov 06, 2026 12:07 AM

Source document DOC-000134: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Nadia Larkspur   MRN: MRN30417491   Admitted: 2026-11-05 21:07
Service: Cardiology   Attending: Dr. Isaac Abernath

History of present illness: 83-year-old woman admitted with CHF. 
Past medical history: type 2 diabetes, hypertension, GERD.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. CHF: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000133 · Viggo Ravensworth, RD (dietitian) · Sat Nov 07, 2026 03:07 AM

Cited facts from this note (8)

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

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… ontext: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.4% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild 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

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… e 70% of needs for 14 days. Weight history: 5.4% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
intake_days: 14 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nadia Larkspur MRN: MRN30417491 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.4% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Rec …
intake_pct: 70 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nadia Larkspur MRN: MRN30417491 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.4% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Rec …
muscle_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… stimated energy intake 70% of needs for 14 days. Weight history: 5.4% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nadia Larkspur MRN: MRN30417491 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.4% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutan …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… istered Dietitian) Patient: Nadia Larkspur MRN: MRN30417491 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.4% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; cal …
weight_loss_pct: 5.4 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… istered Dietitian) Patient: Nadia Larkspur MRN: MRN30417491 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.4% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; cal …

Source document DOC-000133: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Nadia Larkspur   MRN: MRN30417491

Context: acute illness
Intake: estimated energy intake 70% of needs for 14 days.
Weight history: 5.4% weight loss over 30 days.
Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation.
Recommendations: high-protein oral supplement; calorie counts; weekly weights.

Progress note · DOC-000135 · Dr. Priya Thorne (resident) · Sun Nov 08, 2026 12:07 AM

Source document DOC-000135: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Nadia Larkspur   MRN: MRN30417491   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. CHF: continue current management.
2. Moderate protein-calorie malnutrition: dietitian following, supplements.
3. Acute renal insufficiency: trend creatinine, avoid nephrotoxins.

Resident: Dr. Priya Thorne   Attending cosign: completed

Discharge summary · DOC-000136 · Dr. Isaac Abernath (attending) · Sun Nov 08, 2026 04:09 PM

Source document DOC-000136: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Nadia Larkspur   MRN: MRN30417491
Admitted 2026-11-05; discharged 2026-11-08.

Discharge diagnoses:
- moderate protein-calorie malnutrition
- acute renal insufficiency
- CHF
- type 2 diabetes
- hypertension
- GERD

Disposition: home with follow-up.