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-00042: Marisol Thorne

84F · MRN74024635 · Hospital Medicine · admitted Sat Oct 31, 2026 12:25 PM · discharged Wed Nov 04, 2026 01:08 PM · attending Dr. Gideon Zeller · resident Dr. Elena Nakashima · 159 cm, 52.8 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“chronic kidney disease” · N18.9 Chronic kidney disease, unspecified
“hyponatremia” · E87.1 Hypo-osmolality and hyponatremia

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 194.

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=2.181, t.ratio_s1=1.5, creat_rise_48h=0.71, t.rise_abs=0.3, uo_hours_lt_0_5=18, 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=2.181, t.ratio_s3=3.0, creat_peak=3.25, t.scr_s3=4.0, rrt_started=False, uo_hours_lt_0_3=0, t.uo_s3_h=24, anuria_hours=0, 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=2.181, t.ratio_s2=2.0, uo_hours_lt_0_5=18, 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=0.71, 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=F, hgb_nadir=12.9, 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=0.3, 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=0.3, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=12.9, anaemic=False	true

Chronic kidney disease

Criteria met

Specificity gap

Documented “chronic kidney disease” (N18.9); criteria support the more specific Chronic kidney disease stage 3b (N18.32).

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=259, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=34.4, egfr_late=34.4	34.4
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=34.4, t.g2=60, egfr_late=34.4	true
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=34.4, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G3b
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=True, egfr_early=34.4, egfr_late=34.4, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=34.4, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3b	false
outcome: g3b	`category == 'G3b'`	category=G3b	true

Heart failure

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=False	0
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=0, 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=0	false

Hyponatraemia

Clinical judgement required

Clinical judgement required: Low sodium without documented treatment or repeat values; clinical significance is a clinician judgement.

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=133.0, t.profound=125, t.moderate=130, t.low=135	mild
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=133.0, t.low=135, na_low_count=1, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=133.0, t.low=135	true

Malnutrition

Criteria met

Specificity gap

Criteria support Moderate (non-severe) protein-calorie malnutrition (acute illness context) (E44.0); no corresponding diagnosis is documented.

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=9.0, 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=9.0, 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=5.2	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=5.2	true
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=9.0, 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=9.0, 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=5.2	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=5.2	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=60.0, wt_loss_pct=5.2, 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=84, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=20.9, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=20.9, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=20.9, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=20.9, 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=37.2, 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=88.0, 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=20.0, 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=10.5, t.wbc_hi=12, wbc_min_48h=6.17, 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=189.0	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=0.51	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=3.25	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=1.49	1
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=1	1
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=1, 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 (28)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001427	Sat Nov 15, 2025 09:15 AM	creatinine	1.49 mg/dL
LAB-001428	Sun Aug 02, 2026 10:05 AM	creatinine	1.49 mg/dL
LAB-001429	Sat Oct 31, 2026 01:25 PM	creatinine	2.54 mg/dL
LAB-001434	Sat Oct 31, 2026 01:25 PM	sodium	133.0 mmol/L
LAB-001439	Sat Oct 31, 2026 01:25 PM	hemoglobin	13.08 g/dL
LAB-001444	Sat Oct 31, 2026 01:25 PM	wbc	6.17 x10^3/uL
LAB-001445	Sat Oct 31, 2026 01:25 PM	platelets	197.0 x10^3/uL
LAB-001454	Sat Oct 31, 2026 01:25 PM	bilirubin	0.51 mg/dL
LAB-001430	Sun Nov 01, 2026 05:00 AM	creatinine	3.25 mg/dL
LAB-001435	Sun Nov 01, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001440	Sun Nov 01, 2026 05:00 AM	hemoglobin	13.07 g/dL
LAB-001446	Sun Nov 01, 2026 05:00 AM	wbc	10.5 x10^3/uL
LAB-001447	Sun Nov 01, 2026 05:00 AM	platelets	278.0 x10^3/uL
LAB-001431	Mon Nov 02, 2026 05:00 AM	creatinine	2.93 mg/dL
LAB-001436	Mon Nov 02, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001441	Mon Nov 02, 2026 05:00 AM	hemoglobin	13.24 g/dL
LAB-001448	Mon Nov 02, 2026 05:00 AM	wbc	9.16 x10^3/uL
LAB-001449	Mon Nov 02, 2026 05:00 AM	platelets	189.0 x10^3/uL
LAB-001432	Tue Nov 03, 2026 05:00 AM	creatinine	2.44 mg/dL
LAB-001437	Tue Nov 03, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001442	Tue Nov 03, 2026 05:00 AM	hemoglobin	12.9 g/dL
LAB-001450	Tue Nov 03, 2026 05:00 AM	wbc	10.7 x10^3/uL
LAB-001451	Tue Nov 03, 2026 05:00 AM	platelets	180.0 x10^3/uL
LAB-001433	Wed Nov 04, 2026 05:00 AM	creatinine	2.02 mg/dL
LAB-001438	Wed Nov 04, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-001443	Wed Nov 04, 2026 05:00 AM	hemoglobin	13.05 g/dL
LAB-001452	Wed Nov 04, 2026 05:00 AM	wbc	5.9 x10^3/uL
LAB-001453	Wed Nov 04, 2026 05:00 AM	platelets	221.0 x10^3/uL

Vitals (86)

Vitals
Row	When	Kind	Value	Detail
VIT-004088	Sat Oct 31, 2026 12:45 PM	spo2	96.0	room air
VIT-004089	Sat Oct 31, 2026 12:45 PM	rr	20.0
VIT-004114	Sat Oct 31, 2026 12:45 PM	temp_c	36.7
VIT-004115	Sat Oct 31, 2026 12:45 PM	hr	87.0
VIT-004116	Sat Oct 31, 2026 12:45 PM	map	83.0
VIT-004117	Sat Oct 31, 2026 12:45 PM	gcs	15.0
VIT-004080	Sat Oct 31, 2026 06:25 PM	urine_ml_6h	348.5
VIT-004090	Sat Oct 31, 2026 08:45 PM	spo2	97.0	room air
VIT-004091	Sat Oct 31, 2026 08:45 PM	rr	14.0
VIT-004118	Sat Oct 31, 2026 08:45 PM	temp_c	36.9
VIT-004119	Sat Oct 31, 2026 08:45 PM	hr	75.0
VIT-004120	Sat Oct 31, 2026 08:45 PM	map	89.0
VIT-004121	Sat Oct 31, 2026 08:45 PM	gcs	15.0
VIT-004081	Sun Nov 01, 2026 12:25 AM	urine_ml_6h	133.1
VIT-004092	Sun Nov 01, 2026 04:45 AM	spo2	99.0	room air
VIT-004093	Sun Nov 01, 2026 04:45 AM	rr	14.0
VIT-004122	Sun Nov 01, 2026 04:45 AM	temp_c	36.9
VIT-004123	Sun Nov 01, 2026 04:45 AM	hr	88.0
VIT-004124	Sun Nov 01, 2026 04:45 AM	map	77.0
VIT-004125	Sun Nov 01, 2026 04:45 AM	gcs	15.0
VIT-004082	Sun Nov 01, 2026 06:25 AM	urine_ml_6h	133.1
VIT-004083	Sun Nov 01, 2026 12:25 PM	urine_ml_6h	133.1
VIT-004094	Sun Nov 01, 2026 12:45 PM	spo2	97.0	room air
VIT-004095	Sun Nov 01, 2026 12:45 PM	rr	20.0
VIT-004126	Sun Nov 01, 2026 12:45 PM	temp_c	37.2
VIT-004127	Sun Nov 01, 2026 12:45 PM	hr	84.0
VIT-004128	Sun Nov 01, 2026 12:45 PM	map	90.0
VIT-004129	Sun Nov 01, 2026 12:45 PM	gcs	15.0
VIT-004084	Sun Nov 01, 2026 06:25 PM	urine_ml_6h	348.5
VIT-004096	Sun Nov 01, 2026 08:45 PM	spo2	97.0	room air
VIT-004097	Sun Nov 01, 2026 08:45 PM	rr	20.0
VIT-004130	Sun Nov 01, 2026 08:45 PM	temp_c	36.7
VIT-004131	Sun Nov 01, 2026 08:45 PM	hr	74.0
VIT-004132	Sun Nov 01, 2026 08:45 PM	map	80.0
VIT-004133	Sun Nov 01, 2026 08:45 PM	gcs	15.0
VIT-004085	Mon Nov 02, 2026 12:25 AM	urine_ml_6h	348.5
VIT-004098	Mon Nov 02, 2026 04:45 AM	spo2	95.0	room air
VIT-004099	Mon Nov 02, 2026 04:45 AM	rr	15.0
VIT-004134	Mon Nov 02, 2026 04:45 AM	temp_c	37.1
VIT-004135	Mon Nov 02, 2026 04:45 AM	hr	77.0
VIT-004136	Mon Nov 02, 2026 04:45 AM	map	92.0
VIT-004137	Mon Nov 02, 2026 04:45 AM	gcs	15.0
VIT-004086	Mon Nov 02, 2026 06:25 AM	urine_ml_6h	348.5
VIT-004087	Mon Nov 02, 2026 12:25 PM	urine_ml_6h	348.5
VIT-004100	Mon Nov 02, 2026 12:45 PM	spo2	94.0	room air
VIT-004101	Mon Nov 02, 2026 12:45 PM	rr	16.0
VIT-004138	Mon Nov 02, 2026 12:45 PM	temp_c	37.6
VIT-004139	Mon Nov 02, 2026 12:45 PM	hr	80.0
VIT-004140	Mon Nov 02, 2026 12:45 PM	map	82.0
VIT-004141	Mon Nov 02, 2026 12:45 PM	gcs	15.0
VIT-004102	Mon Nov 02, 2026 08:45 PM	spo2	96.0	room air
VIT-004103	Mon Nov 02, 2026 08:45 PM	rr	16.0
VIT-004142	Mon Nov 02, 2026 08:45 PM	temp_c	37.2
VIT-004143	Mon Nov 02, 2026 08:45 PM	hr	90.0
VIT-004144	Mon Nov 02, 2026 08:45 PM	map	88.0
VIT-004145	Mon Nov 02, 2026 08:45 PM	gcs	15.0
VIT-004104	Tue Nov 03, 2026 04:45 AM	spo2	98.0	room air
VIT-004105	Tue Nov 03, 2026 04:45 AM	rr	20.0
VIT-004146	Tue Nov 03, 2026 04:45 AM	temp_c	36.8
VIT-004147	Tue Nov 03, 2026 04:45 AM	hr	76.0
VIT-004148	Tue Nov 03, 2026 04:45 AM	map	85.0
VIT-004149	Tue Nov 03, 2026 04:45 AM	gcs	15.0
VIT-004106	Tue Nov 03, 2026 12:45 PM	spo2	94.0	room air
VIT-004107	Tue Nov 03, 2026 12:45 PM	rr	15.0
VIT-004150	Tue Nov 03, 2026 12:45 PM	temp_c	37.0
VIT-004151	Tue Nov 03, 2026 12:45 PM	hr	82.0
VIT-004152	Tue Nov 03, 2026 12:45 PM	map	76.0
VIT-004153	Tue Nov 03, 2026 12:45 PM	gcs	15.0
VIT-004108	Tue Nov 03, 2026 08:45 PM	spo2	94.0	room air
VIT-004109	Tue Nov 03, 2026 08:45 PM	rr	15.0
VIT-004154	Tue Nov 03, 2026 08:45 PM	temp_c	37.5
VIT-004155	Tue Nov 03, 2026 08:45 PM	hr	84.0
VIT-004156	Tue Nov 03, 2026 08:45 PM	map	88.0
VIT-004157	Tue Nov 03, 2026 08:45 PM	gcs	15.0
VIT-004110	Wed Nov 04, 2026 04:45 AM	spo2	95.0	room air
VIT-004111	Wed Nov 04, 2026 04:45 AM	rr	20.0
VIT-004158	Wed Nov 04, 2026 04:45 AM	temp_c	36.5
VIT-004159	Wed Nov 04, 2026 04:45 AM	hr	71.0
VIT-004160	Wed Nov 04, 2026 04:45 AM	map	76.0
VIT-004161	Wed Nov 04, 2026 04:45 AM	gcs	15.0
VIT-004112	Wed Nov 04, 2026 12:45 PM	spo2	98.0	room air
VIT-004113	Wed Nov 04, 2026 12:45 PM	rr	18.0
VIT-004162	Wed Nov 04, 2026 12:45 PM	temp_c	37.4
VIT-004163	Wed Nov 04, 2026 12:45 PM	hr	75.0
VIT-004164	Wed Nov 04, 2026 12:45 PM	map	80.0
VIT-004165	Wed Nov 04, 2026 12:45 PM	gcs	15.0

Medications, orders, echo, history (4)

MED-000152 10-31 13:25 cefepime per protocol IV
MED-000153 11-01 05:00 piperacillin-tazobactam per protocol IV
MED-000154 11-02 05:00 piperacillin-tazobactam per protocol IV
ORD-000035 10-31 12:55 blood_culture: blood cultures x2

Notes

History and physical · DOC-000142 · Dr. Elena Nakashima (resident) · Sat Oct 31, 2026 03:25 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. Gideon Zeller History of present illness: 84-year-old woman 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: clear to auscultation …

Source document DOC-000142: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Marisol Thorne   MRN: MRN74024635   Admitted: 2026-10-31 12:25
Service: Hospital Medicine   Attending: Dr. Gideon Zeller

History of present illness: 84-year-old woman 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: clear to auscultation bilaterally.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.
2. Chronic kidney disease: renally dose medications.

Nutrition assessment · DOC-000141 · Dario Larkspur, RD (dietitian) · Sun Nov 01, 2026 02:25 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 9 days. Weight history: 5.2% 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

Show source for fluid_accumulation

… ke 60% of needs for 9 days. Weight history: 5.2% 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: 9 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Marisol Thorne MRN: MRN74024635 Context: acute illness Intake: estimated energy intake 60% of needs for 9 days. Weight history: 5.2% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Rec …
intake_pct: 60 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Marisol Thorne MRN: MRN74024635 Context: acute illness Intake: estimated energy intake 60% of needs for 9 days. Weight history: 5.2% 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

… estimated energy intake 60% of needs for 9 days. Weight history: 5.2% 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: Marisol Thorne MRN: MRN74024635 Context: acute illness Intake: estimated energy intake 60% of needs for 9 days. Weight history: 5.2% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutane …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… gistered Dietitian) Patient: Marisol Thorne MRN: MRN74024635 Context: acute illness Intake: estimated energy intake 60% of needs for 9 days. Weight history: 5.2% 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: 5.2 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… gistered Dietitian) Patient: Marisol Thorne MRN: MRN74024635 Context: acute illness Intake: estimated energy intake 60% of needs for 9 days. Weight history: 5.2% 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-000141: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Marisol Thorne   MRN: MRN74024635

Context: acute illness
Intake: estimated energy intake 60% of needs for 9 days.
Weight history: 5.2% 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-000143 · Dr. Elena Nakashima (resident) · Mon Nov 02, 2026 12:25 PM

Source document DOC-000143: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Marisol Thorne   MRN: MRN74024635   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. Hyponatremia: trend sodium.

Resident: Dr. Elena Nakashima   Attending cosign: completed

Discharge summary · DOC-000144 · Dr. Gideon Zeller (attending) · Wed Nov 04, 2026 01:08 PM

Source document DOC-000144: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Marisol Thorne   MRN: MRN74024635
Admitted 2026-10-31; discharged 2026-11-04.

Discharge diagnoses:
- community-acquired pneumonia
- chronic kidney disease
- hyponatremia

Disposition: home with follow-up.