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-00041: Ines Nakashima

79M · MRN18142134 · Hospital Medicine · admitted Sat Oct 31, 2026 12:31 PM · discharged Thu Nov 05, 2026 10:28 AM · attending Dr. Wes Merriweather · resident Dr. Noor Halvorsen · 163 cm, 56.6 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“severe malnutrition” · E43 Unspecified severe protein-calorie malnutrition
“heart failure” · I50.9 Heart failure, unspecified

Illustrative grouping now: MS-DRG 193 Simple pneumonia and pleurisy with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 194.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

No gap

Not documented and not supported.

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=1.038, t.ratio_s1=1.5, creat_rise_48h=0.03, 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=1.038, t.ratio_s3=3.0, creat_peak=1.09, 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=1.038, 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=0.03, 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=M, hgb_nadir=14.53, 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=14.53, 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=177, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=70.6, egfr_late=72.2	72.2
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=70.6, t.g2=60, egfr_late=72.2	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=72.2, 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=70.6, egfr_late=72.2, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=72.2, 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=51.0, 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=32.0, 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=32.0, 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=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 met

Specificity gap

Criteria support Hyponatraemia (moderate) (E87.1); no corresponding diagnosis is documented.

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=129.0, t.profound=125, t.moderate=130, t.low=135	moderate
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=129.0, t.low=135, na_low_count=5, t.repeat=2, na_treated=True	true

Malnutrition

Criteria met

Clinical validation gap

Documented “severe malnutrition” (E43) conflicts with what the criteria support (Moderate (non-severe) protein-calorie malnutrition (acute illness context), 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=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=30.0, wt_loss_pct=3.0	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=30.0, wt_loss_pct=3.0	false
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=30.0, wt_loss_pct=3.0	false
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=3.0	false
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=60.0, wt_loss_pct=3.0, 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=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=False	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=False, a_mod_wt=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=False, c_mod_wt=False	3
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=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=79, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=21.3, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=21.3, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=21.3, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=21.3, 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 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=36.8, 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=8.11, t.wbc_hi=12, wbc_min_48h=5.58, 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=241.0	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=0.91	0
derived: sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`	norepi_max_48h=0.0, map_min_48h=77.0	0
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=1.09	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=1.05	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=True, sofa_delta=0, t.sofa_delta=2	false
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=False, 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=False, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=False	false
outcome: definitions_disagree	`sepsis2`	sepsis2=False	false
outcome: neither	`true`	—	true

Structured data

Labs (34)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001393	Sun Jan 18, 2026 09:15 AM	creatinine	1.07 mg/dL
LAB-001394	Wed Jul 15, 2026 10:05 AM	creatinine	1.05 mg/dL
LAB-001395	Sat Oct 31, 2026 01:31 PM	creatinine	1.06 mg/dL
LAB-001401	Sat Oct 31, 2026 01:31 PM	bnp	51.0 pg/mL
LAB-001402	Sat Oct 31, 2026 01:31 PM	sodium	131.0 mmol/L
LAB-001408	Sat Oct 31, 2026 01:31 PM	hemoglobin	14.58 g/dL
LAB-001414	Sat Oct 31, 2026 01:31 PM	wbc	7.75 x10^3/uL
LAB-001415	Sat Oct 31, 2026 01:31 PM	platelets	306.0 x10^3/uL
LAB-001426	Sat Oct 31, 2026 01:31 PM	bilirubin	0.91 mg/dL
LAB-001396	Sun Nov 01, 2026 05:00 AM	creatinine	1.09 mg/dL
LAB-001403	Sun Nov 01, 2026 05:00 AM	sodium	129.0 mmol/L
LAB-001409	Sun Nov 01, 2026 05:00 AM	hemoglobin	15.0 g/dL
LAB-001416	Sun Nov 01, 2026 05:00 AM	wbc	5.58 x10^3/uL
LAB-001417	Sun Nov 01, 2026 05:00 AM	platelets	241.0 x10^3/uL
LAB-001397	Mon Nov 02, 2026 05:00 AM	creatinine	1.07 mg/dL
LAB-001404	Mon Nov 02, 2026 05:00 AM	sodium	130.0 mmol/L
LAB-001410	Mon Nov 02, 2026 05:00 AM	hemoglobin	14.53 g/dL
LAB-001418	Mon Nov 02, 2026 05:00 AM	wbc	8.11 x10^3/uL
LAB-001419	Mon Nov 02, 2026 05:00 AM	platelets	256.0 x10^3/uL
LAB-001398	Tue Nov 03, 2026 05:00 AM	creatinine	1.08 mg/dL
LAB-001405	Tue Nov 03, 2026 05:00 AM	sodium	133.0 mmol/L
LAB-001411	Tue Nov 03, 2026 05:00 AM	hemoglobin	14.54 g/dL
LAB-001420	Tue Nov 03, 2026 05:00 AM	wbc	5.85 x10^3/uL
LAB-001421	Tue Nov 03, 2026 05:00 AM	platelets	180.0 x10^3/uL
LAB-001399	Wed Nov 04, 2026 05:00 AM	creatinine	1.09 mg/dL
LAB-001406	Wed Nov 04, 2026 05:00 AM	sodium	135.0 mmol/L
LAB-001412	Wed Nov 04, 2026 05:00 AM	hemoglobin	14.71 g/dL
LAB-001422	Wed Nov 04, 2026 05:00 AM	wbc	10.51 x10^3/uL
LAB-001423	Wed Nov 04, 2026 05:00 AM	platelets	177.0 x10^3/uL
LAB-001400	Thu Nov 05, 2026 05:00 AM	creatinine	1.05 mg/dL
LAB-001407	Thu Nov 05, 2026 05:00 AM	sodium	134.0 mmol/L
LAB-001413	Thu Nov 05, 2026 05:00 AM	hemoglobin	15.01 g/dL
LAB-001424	Thu Nov 05, 2026 05:00 AM	wbc	6.57 x10^3/uL
LAB-001425	Thu Nov 05, 2026 05:00 AM	platelets	221.0 x10^3/uL

Vitals (90)

Vitals
Row	When	Kind	Value	Detail
VIT-003990	Sat Oct 31, 2026 12:51 PM	spo2	94.0	room air
VIT-003991	Sat Oct 31, 2026 12:51 PM	rr	15.0
VIT-004020	Sat Oct 31, 2026 12:51 PM	temp_c	37.1
VIT-004021	Sat Oct 31, 2026 12:51 PM	hr	86.0
VIT-004022	Sat Oct 31, 2026 12:51 PM	map	77.0
VIT-004023	Sat Oct 31, 2026 12:51 PM	gcs	15.0
VIT-003992	Sat Oct 31, 2026 08:51 PM	spo2	94.0	room air
VIT-003993	Sat Oct 31, 2026 08:51 PM	rr	15.0
VIT-004024	Sat Oct 31, 2026 08:51 PM	temp_c	37.4
VIT-004025	Sat Oct 31, 2026 08:51 PM	hr	74.0
VIT-004026	Sat Oct 31, 2026 08:51 PM	map	79.0
VIT-004027	Sat Oct 31, 2026 08:51 PM	gcs	15.0
VIT-003994	Sun Nov 01, 2026 04:51 AM	spo2	98.0	room air
VIT-003995	Sun Nov 01, 2026 04:51 AM	rr	18.0
VIT-004028	Sun Nov 01, 2026 04:51 AM	temp_c	37.4
VIT-004029	Sun Nov 01, 2026 04:51 AM	hr	87.0
VIT-004030	Sun Nov 01, 2026 04:51 AM	map	91.0
VIT-004031	Sun Nov 01, 2026 04:51 AM	gcs	15.0
VIT-003996	Sun Nov 01, 2026 12:51 PM	spo2	96.0	room air
VIT-003997	Sun Nov 01, 2026 12:51 PM	rr	16.0
VIT-004032	Sun Nov 01, 2026 12:51 PM	temp_c	36.8
VIT-004033	Sun Nov 01, 2026 12:51 PM	hr	72.0
VIT-004034	Sun Nov 01, 2026 12:51 PM	map	80.0
VIT-004035	Sun Nov 01, 2026 12:51 PM	gcs	15.0
VIT-003998	Sun Nov 01, 2026 08:51 PM	spo2	96.0	room air
VIT-003999	Sun Nov 01, 2026 08:51 PM	rr	19.0
VIT-004036	Sun Nov 01, 2026 08:51 PM	temp_c	37.1
VIT-004037	Sun Nov 01, 2026 08:51 PM	hr	74.0
VIT-004038	Sun Nov 01, 2026 08:51 PM	map	80.0
VIT-004039	Sun Nov 01, 2026 08:51 PM	gcs	15.0
VIT-004000	Mon Nov 02, 2026 04:51 AM	spo2	98.0	room air
VIT-004001	Mon Nov 02, 2026 04:51 AM	rr	15.0
VIT-004040	Mon Nov 02, 2026 04:51 AM	temp_c	37.1
VIT-004041	Mon Nov 02, 2026 04:51 AM	hr	75.0
VIT-004042	Mon Nov 02, 2026 04:51 AM	map	84.0
VIT-004043	Mon Nov 02, 2026 04:51 AM	gcs	15.0
VIT-004002	Mon Nov 02, 2026 12:51 PM	spo2	98.0	room air
VIT-004003	Mon Nov 02, 2026 12:51 PM	rr	19.0
VIT-004044	Mon Nov 02, 2026 12:51 PM	temp_c	36.8
VIT-004045	Mon Nov 02, 2026 12:51 PM	hr	74.0
VIT-004046	Mon Nov 02, 2026 12:51 PM	map	75.0
VIT-004047	Mon Nov 02, 2026 12:51 PM	gcs	15.0
VIT-004004	Mon Nov 02, 2026 08:51 PM	spo2	97.0	room air
VIT-004005	Mon Nov 02, 2026 08:51 PM	rr	17.0
VIT-004048	Mon Nov 02, 2026 08:51 PM	temp_c	37.2
VIT-004049	Mon Nov 02, 2026 08:51 PM	hr	68.0
VIT-004050	Mon Nov 02, 2026 08:51 PM	map	76.0
VIT-004051	Mon Nov 02, 2026 08:51 PM	gcs	15.0
VIT-004006	Tue Nov 03, 2026 04:51 AM	spo2	95.0	room air
VIT-004007	Tue Nov 03, 2026 04:51 AM	rr	14.0
VIT-004052	Tue Nov 03, 2026 04:51 AM	temp_c	36.6
VIT-004053	Tue Nov 03, 2026 04:51 AM	hr	79.0
VIT-004054	Tue Nov 03, 2026 04:51 AM	map	78.0
VIT-004055	Tue Nov 03, 2026 04:51 AM	gcs	15.0
VIT-004008	Tue Nov 03, 2026 12:51 PM	spo2	99.0	room air
VIT-004009	Tue Nov 03, 2026 12:51 PM	rr	17.0
VIT-004056	Tue Nov 03, 2026 12:51 PM	temp_c	36.6
VIT-004057	Tue Nov 03, 2026 12:51 PM	hr	79.0
VIT-004058	Tue Nov 03, 2026 12:51 PM	map	91.0
VIT-004059	Tue Nov 03, 2026 12:51 PM	gcs	15.0
VIT-004010	Tue Nov 03, 2026 08:51 PM	spo2	98.0	room air
VIT-004011	Tue Nov 03, 2026 08:51 PM	rr	14.0
VIT-004060	Tue Nov 03, 2026 08:51 PM	temp_c	36.6
VIT-004061	Tue Nov 03, 2026 08:51 PM	hr	90.0
VIT-004062	Tue Nov 03, 2026 08:51 PM	map	78.0
VIT-004063	Tue Nov 03, 2026 08:51 PM	gcs	15.0
VIT-004012	Wed Nov 04, 2026 04:51 AM	spo2	95.0	room air
VIT-004013	Wed Nov 04, 2026 04:51 AM	rr	14.0
VIT-004064	Wed Nov 04, 2026 04:51 AM	temp_c	37.5
VIT-004065	Wed Nov 04, 2026 04:51 AM	hr	70.0
VIT-004066	Wed Nov 04, 2026 04:51 AM	map	89.0
VIT-004067	Wed Nov 04, 2026 04:51 AM	gcs	15.0
VIT-004014	Wed Nov 04, 2026 12:51 PM	spo2	98.0	room air
VIT-004015	Wed Nov 04, 2026 12:51 PM	rr	15.0
VIT-004068	Wed Nov 04, 2026 12:51 PM	temp_c	36.8
VIT-004069	Wed Nov 04, 2026 12:51 PM	hr	81.0
VIT-004070	Wed Nov 04, 2026 12:51 PM	map	75.0
VIT-004071	Wed Nov 04, 2026 12:51 PM	gcs	15.0
VIT-004016	Wed Nov 04, 2026 08:51 PM	spo2	97.0	room air
VIT-004017	Wed Nov 04, 2026 08:51 PM	rr	17.0
VIT-004072	Wed Nov 04, 2026 08:51 PM	temp_c	37.0
VIT-004073	Wed Nov 04, 2026 08:51 PM	hr	69.0
VIT-004074	Wed Nov 04, 2026 08:51 PM	map	90.0
VIT-004075	Wed Nov 04, 2026 08:51 PM	gcs	15.0
VIT-004018	Thu Nov 05, 2026 04:51 AM	spo2	98.0	room air
VIT-004019	Thu Nov 05, 2026 04:51 AM	rr	14.0
VIT-004076	Thu Nov 05, 2026 04:51 AM	temp_c	36.9
VIT-004077	Thu Nov 05, 2026 04:51 AM	hr	74.0
VIT-004078	Thu Nov 05, 2026 04:51 AM	map	92.0
VIT-004079	Thu Nov 05, 2026 04:51 AM	gcs	15.0

Medications, orders, echo, history (7)

MED-000148 10-31 13:31 piperacillin-tazobactam per protocol IV
MED-000149 11-01 05:00 piperacillin-tazobactam per protocol IV
MED-000150 11-02 05:00 ceftriaxone per protocol IV
MED-000151 10-31 15:31 furosemide 40 mg IV
ORD-000033 10-31 13:01 blood_culture: blood cultures x2
ORD-000034 10-31 15:31 fluid_restriction: fluid restriction 1.2 L/day
ECH-000019 2026-11-01 echo LVEF 32.0%

Notes

History and physical · DOC-000138 · Dr. Noor Halvorsen (resident) · Sat Oct 31, 2026 03:31 PM

Cited facts from this note (1)

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

Show source for infection_source

… Hospital Medicine Attending: Dr. Wes Merriweather History of present illness: 79-year-old man admitted with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: none significant. Review of systems otherwise negative. Exam: Lungs: scattered crackles at …

Source document DOC-000138: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Ines Nakashima   MRN: MRN18142134   Admitted: 2026-10-31 12:31
Service: Hospital Medicine   Attending: Dr. Wes Merriweather

History of present illness: 79-year-old man admitted with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: none significant.
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-000137 · Viggo Ravensworth, RD (dietitian) · Sun Nov 01, 2026 05:31 PM

Cited facts from this note (8)

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

Show source for fat_loss

… Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… ake 60% of needs for 10 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
intake_days: 10 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Ines Nakashima MRN: MRN18142134 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip …
intake_pct: 60 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Ines Nakashima MRN: MRN18142134 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip …
muscle_loss: mild · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… estimated energy intake 60% of needs for 10 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets criteria for non-severe (moderate) malnutrition.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Ines Nakashima MRN: MRN18142134 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneo …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… istered Dietitian) Patient: Ines Nakashima MRN: MRN18142134 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets cri …
weight_loss_pct: 3 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… istered Dietitian) Patient: Ines Nakashima MRN: MRN18142134 Context: acute illness Intake: estimated energy intake 60% of needs for 10 days. Weight history: 3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Grip strength: not assessed. Assessment: meets cri …

Source document DOC-000137: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Ines Nakashima   MRN: MRN18142134

Context: acute illness
Intake: estimated energy intake 60% of needs for 10 days.
Weight history: 3% weight loss over 30 days.
Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation.
Grip strength: not assessed.
Assessment: meets criteria for non-severe (moderate) malnutrition.

Progress note · DOC-000139 · Dr. Noor Halvorsen (resident) · Mon Nov 02, 2026 02:31 PM

Source document DOC-000139: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Ines Nakashima   MRN: MRN18142134   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. Severe malnutrition: dietitian following, supplements.
3. Heart failure: diuresis and daily weights; monitor electrolytes.

Resident: Dr. Noor Halvorsen   Attending cosign: completed

Discharge summary · DOC-000140 · Dr. Wes Merriweather (attending) · Thu Nov 05, 2026 10:28 AM

Source document DOC-000140: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Ines Nakashima   MRN: MRN18142134
Admitted 2026-10-31; discharged 2026-11-05.

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

Disposition: home with follow-up.