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Exact Dx synthetic data · demonstration
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.

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ENC-00043: Nico Ravensworth

86F · MRN51596753 · Cardiology · admitted Thu Oct 29, 2026 08:52 AM · discharged Thu Nov 05, 2026 12:42 PM · attending Dr. Jalen Carrow · resident Dr. Greta Kowalczyk · 154 cm, 52.1 kg

Documented diagnoses (current)

  • “malnourished” · E46 Unspecified protein-calorie malnutrition
  • Principal: “CHF” · I50.9 Heart failure, unspecified
  • “hyponatremia” · E87.1 Hypo-osmolality and hyponatremia
  • “anemia” · D64.9 Anemia, unspecified
  • “stage 4 sacral pressure ulcer” · L89.154 Pressure ulcer of sacral region, stage 4

Illustrative grouping now: MS-DRG 291 Heart failure and shock with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 293.

Queries and events

No queries yet.

All rules applied

Every rule's outcome for this encounter (clean results included)
RuleCriteriaFindingOutcome
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)
StepExpressionInputs and thresholds readResult
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=1.064, 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=1.064, t.ratio_s3=3.0, creat_peak=0.5, 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=1.064, 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 met No gap Supported as documented (D64.9).
Trace
Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
StepExpressionInputs and thresholds readResult
derived: anaemic case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null) sex=F, hgb_nadir=10.54, t.hb_m=13, t.hb_f=12 true
derived: acute_fall hgb_drop >= t.drop_major or prbc_units >= t.prbc_major hgb_drop=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=True, anaemic=True, acute_fall=False false
outcome: anaemia_only anaemic and hgb_drop < t.drop_min and prbc_units == 0 anaemic=True, hgb_drop=0.3, t.drop_min=1.0, prbc_units=0 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)
StepExpressionInputs and thresholds readResult
derived: chronic egfr_n >= 2 and egfr_span_days >= t.chronic_days egfr_n=2, egfr_span_days=203, t.chronic_days=90 true
derived: staging_egfr max(egfr_early, egfr_late) egfr_early=92.2, egfr_late=92.7 92.7
derived: both_below_60 egfr_early < t.g2 and egfr_late < t.g2 egfr_early=92.2, t.g2=60, egfr_late=92.7 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=92.7, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15 G1-G2
outcome: duration_not_shown not chronic chronic=True false
outcome: straddles_60 not both_below_60 and min(egfr_early, egfr_late) < t.g2 both_below_60=False, egfr_early=92.2, egfr_late=92.7, t.g2=60 false
outcome: g1_g2 staging_egfr >= t.g2 staging_egfr=92.7, t.g2=60 true
Heart failure Clinical judgement required Clinical judgement required Clinical judgement required: LVEF 46% (HFmrEF, 41-49%); the type wording and its coding convention need the clinician.
Trace
Rule trace (rule heart_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
StepExpressionInputs and thresholds readResult
derived: np_elevated coalesce(bnp_max >= t.bnp, false) or coalesce(ntprobnp_max >= t.ntprobnp, false) bnp_max=1941.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300 true
derived: acute_count count(iv_loop_diuretic, np_elevated, new_o2) iv_loop_diuretic=True, np_elevated=True, new_o2=False 2
derived: hf_type case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange') lvef=46.0, t.ref=40, t.pres=50 midrange
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=46.0, 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=2, hf_history=True acute on chronic
outcome: improved_ef improved improved=False false
outcome: midrange hf_type == 'midrange' hf_type=midrange true
Hyponatraemia Criteria not met Clinical validation gap Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 136).
Trace
Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
StepExpressionInputs and thresholds readResult
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 not met Clinical validation gap Documented “malnourished” (E46) but the criteria are not met: 4 characteristics assessed and none met.
Trace
Rule trace (rule malnutrition v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
StepExpressionInputs and thresholds readResult
derived: a_sev_intake intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days intake_pct=100.0, t.a_sev_intake_pct=50, intake_days=unknown, 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=100.0, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7 false
derived: a_sev_wt (wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) wt_loss_days=unknown, wt_loss_pct=unknown unknown
derived: a_mod_wt (wt_loss_days <= 7 and wt_loss_pct >= 1) or (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) wt_loss_days=unknown, wt_loss_pct=unknown unknown
derived: c_sev_intake intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days intake_pct=100.0, t.c_intake_pct=75, intake_days=unknown, 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=100.0, t.c_intake_pct=75, intake_days=unknown, 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=unknown, wt_loss_pct=unknown unknown
derived: c_mod_wt (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) or (wt_loss_days <= 183 and wt_loss_pct >= 10) or (wt_loss_days <= 366 and wt_loss_pct >= 20) wt_loss_days=unknown, wt_loss_pct=unknown unknown
derived: n_assessed known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced) intake_pct=100.0, wt_loss_pct=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown 4
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=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=unknown 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=False, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=0, muscle_loss=0, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_mod_intake=False, c_sev_wt=unknown, c_mod_wt=unknown 0
outcome: severe n_severe >= 2 n_severe=0 false
outcome: moderate n_moderate >= 2 n_moderate=0 false
outcome: one_characteristic n_moderate == 1 n_moderate=0 false
outcome: not_met n_moderate == 0 and n_assessed >= 2 n_moderate=0, n_assessed=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)
StepExpressionInputs and thresholds readResult
outcome: not_adult age < t.adult age=86, t.adult=20 false
outcome: class3 bmi >= t.c3 bmi=22.0, t.c3=40 false
outcome: class2 bmi >= t.c2 bmi=22.0, t.c2=35 false
outcome: class1 bmi >= t.c1 bmi=22.0, t.c1=30 false
outcome: not_met bmi < t.c1 bmi=22.0, t.c1=30 true
Pressure injury Criteria met Clinical validation gap Documented “stage 4 sacral pressure ulcer” (L89.154) conflicts with what the criteria support (Pressure injury of sacral region, stage 2, L89.152).
Trace
Rule trace (rule pressure_injury v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
StepExpressionInputs and thresholds readResult
derived: sacral wound_site == 'sacral' wound_site=sacral true
outcome: no_wound_note not present(wound_stage) wound_stage=2 false
outcome: other_site wound_site != 'sacral' wound_site=sacral false
outcome: stage1 sacral and wound_stage == '1' sacral=True, wound_stage=2 false
outcome: stage2 sacral and wound_stage == '2' sacral=True, wound_stage=2 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)
StepExpressionInputs and thresholds readResult
derived: measured present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min) spo2_min_ra=95.0, 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=95.0, 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)
StepExpressionInputs and thresholds readResult
derived: sirs_temp coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false) temp_max_48h=37.0, t.t_hi=38, temp_min_48h=36.5, t.t_lo=36 false
derived: sirs_hr coalesce(hr_max_48h > t.hr, false) hr_max_48h=78.0, 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=7.98, t.wbc_hi=12, wbc_min_48h=6.38, 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=0.47 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=74.0 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=0.49 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=0.47 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 (44)
Labs (pre-admission rows are outpatient values)
RowWhenTestValue
LAB-001455Tue Dec 30, 2025 09:15 AMcreatinine0.48 mg/dL
LAB-001456Wed Jul 22, 2026 10:05 AMcreatinine0.47 mg/dL
LAB-001457Thu Oct 29, 2026 09:52 AMcreatinine0.47 mg/dL
LAB-001465Thu Oct 29, 2026 09:52 AMbnp1941.0 pg/mL
LAB-001466Thu Oct 29, 2026 09:52 AMsodium137.0 mmol/L
LAB-001474Thu Oct 29, 2026 09:52 AMhemoglobin10.74 g/dL
LAB-001482Thu Oct 29, 2026 09:52 AMwbc7.98 x10^3/uL
LAB-001483Thu Oct 29, 2026 09:52 AMplatelets267.0 x10^3/uL
LAB-001498Thu Oct 29, 2026 09:52 AMbilirubin0.47 mg/dL
LAB-001458Fri Oct 30, 2026 05:00 AMcreatinine0.49 mg/dL
LAB-001467Fri Oct 30, 2026 05:00 AMsodium136.0 mmol/L
LAB-001475Fri Oct 30, 2026 05:00 AMhemoglobin10.8 g/dL
LAB-001484Fri Oct 30, 2026 05:00 AMwbc6.96 x10^3/uL
LAB-001485Fri Oct 30, 2026 05:00 AMplatelets200.0 x10^3/uL
LAB-001459Sat Oct 31, 2026 05:00 AMcreatinine0.49 mg/dL
LAB-001468Sat Oct 31, 2026 05:00 AMsodium139.0 mmol/L
LAB-001476Sat Oct 31, 2026 05:00 AMhemoglobin10.54 g/dL
LAB-001486Sat Oct 31, 2026 05:00 AMwbc6.38 x10^3/uL
LAB-001487Sat Oct 31, 2026 05:00 AMplatelets189.0 x10^3/uL
LAB-001460Sun Nov 01, 2026 05:00 AMcreatinine0.48 mg/dL
LAB-001469Sun Nov 01, 2026 05:00 AMsodium141.0 mmol/L
LAB-001477Sun Nov 01, 2026 05:00 AMhemoglobin10.58 g/dL
LAB-001488Sun Nov 01, 2026 05:00 AMwbc9.74 x10^3/uL
LAB-001489Sun Nov 01, 2026 05:00 AMplatelets291.0 x10^3/uL
LAB-001461Mon Nov 02, 2026 05:00 AMcreatinine0.47 mg/dL
LAB-001470Mon Nov 02, 2026 05:00 AMsodium140.0 mmol/L
LAB-001478Mon Nov 02, 2026 05:00 AMhemoglobin10.86 g/dL
LAB-001490Mon Nov 02, 2026 05:00 AMwbc7.82 x10^3/uL
LAB-001491Mon Nov 02, 2026 05:00 AMplatelets249.0 x10^3/uL
LAB-001462Tue Nov 03, 2026 05:00 AMcreatinine0.5 mg/dL
LAB-001471Tue Nov 03, 2026 05:00 AMsodium140.0 mmol/L
LAB-001479Tue Nov 03, 2026 05:00 AMhemoglobin10.64 g/dL
LAB-001492Tue Nov 03, 2026 05:00 AMwbc10.55 x10^3/uL
LAB-001493Tue Nov 03, 2026 05:00 AMplatelets273.0 x10^3/uL
LAB-001463Wed Nov 04, 2026 05:00 AMcreatinine0.47 mg/dL
LAB-001472Wed Nov 04, 2026 05:00 AMsodium141.0 mmol/L
LAB-001480Wed Nov 04, 2026 05:00 AMhemoglobin10.56 g/dL
LAB-001494Wed Nov 04, 2026 05:00 AMwbc8.15 x10^3/uL
LAB-001495Wed Nov 04, 2026 05:00 AMplatelets293.0 x10^3/uL
LAB-001464Thu Nov 05, 2026 05:00 AMcreatinine0.47 mg/dL
LAB-001473Thu Nov 05, 2026 05:00 AMsodium139.0 mmol/L
LAB-001481Thu Nov 05, 2026 05:00 AMhemoglobin10.88 g/dL
LAB-001496Thu Nov 05, 2026 05:00 AMwbc10.91 x10^3/uL
LAB-001497Thu Nov 05, 2026 05:00 AMplatelets247.0 x10^3/uL
Vitals (132)
Vitals
RowWhenKindValueDetail
VIT-004166Thu Oct 29, 2026 09:12 AMspo299.0room air
VIT-004167Thu Oct 29, 2026 09:12 AMrr16.0
VIT-004210Thu Oct 29, 2026 09:12 AMtemp_c36.8
VIT-004211Thu Oct 29, 2026 09:12 AMhr71.0
VIT-004212Thu Oct 29, 2026 09:12 AMmap74.0
VIT-004213Thu Oct 29, 2026 09:12 AMgcs15.0
VIT-004168Thu Oct 29, 2026 05:12 PMspo297.0room air
VIT-004169Thu Oct 29, 2026 05:12 PMrr14.0
VIT-004214Thu Oct 29, 2026 05:12 PMtemp_c36.5
VIT-004215Thu Oct 29, 2026 05:12 PMhr78.0
VIT-004216Thu Oct 29, 2026 05:12 PMmap83.0
VIT-004217Thu Oct 29, 2026 05:12 PMgcs15.0
VIT-004170Fri Oct 30, 2026 01:12 AMspo297.0room air
VIT-004171Fri Oct 30, 2026 01:12 AMrr15.0
VIT-004218Fri Oct 30, 2026 01:12 AMtemp_c36.7
VIT-004219Fri Oct 30, 2026 01:12 AMhr76.0
VIT-004220Fri Oct 30, 2026 01:12 AMmap90.0
VIT-004221Fri Oct 30, 2026 01:12 AMgcs15.0
VIT-004172Fri Oct 30, 2026 09:12 AMspo295.0room air
VIT-004173Fri Oct 30, 2026 09:12 AMrr18.0
VIT-004222Fri Oct 30, 2026 09:12 AMtemp_c37.0
VIT-004223Fri Oct 30, 2026 09:12 AMhr71.0
VIT-004224Fri Oct 30, 2026 09:12 AMmap87.0
VIT-004225Fri Oct 30, 2026 09:12 AMgcs15.0
VIT-004174Fri Oct 30, 2026 05:12 PMspo296.0room air
VIT-004175Fri Oct 30, 2026 05:12 PMrr15.0
VIT-004226Fri Oct 30, 2026 05:12 PMtemp_c36.6
VIT-004227Fri Oct 30, 2026 05:12 PMhr68.0
VIT-004228Fri Oct 30, 2026 05:12 PMmap80.0
VIT-004229Fri Oct 30, 2026 05:12 PMgcs15.0
VIT-004176Sat Oct 31, 2026 01:12 AMspo297.0room air
VIT-004177Sat Oct 31, 2026 01:12 AMrr19.0
VIT-004230Sat Oct 31, 2026 01:12 AMtemp_c36.9
VIT-004231Sat Oct 31, 2026 01:12 AMhr75.0
VIT-004232Sat Oct 31, 2026 01:12 AMmap90.0
VIT-004233Sat Oct 31, 2026 01:12 AMgcs15.0
VIT-004178Sat Oct 31, 2026 09:12 AMspo296.0room air
VIT-004179Sat Oct 31, 2026 09:12 AMrr20.0
VIT-004234Sat Oct 31, 2026 09:12 AMtemp_c37.5
VIT-004235Sat Oct 31, 2026 09:12 AMhr88.0
VIT-004236Sat Oct 31, 2026 09:12 AMmap74.0
VIT-004237Sat Oct 31, 2026 09:12 AMgcs15.0
VIT-004180Sat Oct 31, 2026 05:12 PMspo298.0room air
VIT-004181Sat Oct 31, 2026 05:12 PMrr17.0
VIT-004238Sat Oct 31, 2026 05:12 PMtemp_c37.6
VIT-004239Sat Oct 31, 2026 05:12 PMhr81.0
VIT-004240Sat Oct 31, 2026 05:12 PMmap88.0
VIT-004241Sat Oct 31, 2026 05:12 PMgcs15.0
VIT-004182Sun Nov 01, 2026 01:12 AMspo297.0room air
VIT-004183Sun Nov 01, 2026 01:12 AMrr18.0
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VIT-004186Sun Nov 01, 2026 05:12 PMspo299.0room air
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VIT-004250Sun Nov 01, 2026 05:12 PMtemp_c36.6
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VIT-004188Mon Nov 02, 2026 01:12 AMspo296.0room air
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VIT-004254Mon Nov 02, 2026 01:12 AMtemp_c37.3
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VIT-004190Mon Nov 02, 2026 09:12 AMspo295.0room air
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VIT-004196Tue Nov 03, 2026 09:12 AMspo297.0room air
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VIT-004270Tue Nov 03, 2026 09:12 AMtemp_c37.2
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VIT-004200Wed Nov 04, 2026 01:12 AMspo296.0room air
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VIT-004278Wed Nov 04, 2026 01:12 AMtemp_c37.3
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VIT-004293Thu Nov 05, 2026 01:12 AMgcs15.0
VIT-004208Thu Nov 05, 2026 09:12 AMspo299.0room air
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VIT-004294Thu Nov 05, 2026 09:12 AMtemp_c37.1
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VIT-004297Thu Nov 05, 2026 09:12 AMgcs15.0
Medications, orders, echo, history (8)

Notes

History and physical · DOC-000147 · Dr. Greta Kowalczyk (resident) · Thu Oct 29, 2026 11:52 AM

Cited facts from this note (1)
bleeding_source
bleeding · cited p. 1, line 7 · confidence 0.50
Show source for bleeding_source
… Dr. Jalen Carrow History of present illness: 86-year-old woman admitted with CHF. Past medical history: heart failure with reduced ejection fraction. Denies bleeding, chest pain or fever. Exam: Lungs: scattered crackles at the bases, no distress. Assessment and plan: 1. CHF: diuresis and daily weights; monitor electrolytes.
Source document DOC-000147: History and physical (synthetic)
HISTORY AND PHYSICAL
Patient: Nico Ravensworth   MRN: MRN51596753   Admitted: 2026-10-29 08:52
Service: Cardiology   Attending: Dr. Jalen Carrow

History of present illness: 86-year-old woman admitted with CHF. 
Past medical history: heart failure with reduced ejection fraction.
Denies bleeding, chest pain or fever.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. CHF: diuresis and daily weights; monitor electrolytes.

Wound care note · DOC-000146 · Elena Jessup, RN, CWOCN (wound_nurse) · Fri Oct 30, 2026 09:52 AM

Cited facts from this note (2)
wound_site
sacral · cited p. 1, line 4 · confidence 0.95
Show source for wound_site
WOUND CARE NOTE Patient: Nico Ravensworth MRN: MRN51596753 Location: sacrum Stage: 2 (NPIAP) Description: partial-thickness skin loss with exposed dermis. Size: 2.0 x 3.9 x 0.4 cm. Plan: offloading every 2 hours, foam dressing, nutriti …
wound_stage
2 · cited p. 1, line 5 · confidence 0.95
Show source for wound_stage
WOUND CARE NOTE Patient: Nico Ravensworth MRN: MRN51596753 Location: sacrum Stage: 2 (NPIAP) Description: partial-thickness skin loss with exposed dermis. Size: 2.0 x 3.9 x 0.4 cm. Plan: offloading every 2 hours, foam dressing, nutrition consul …
Source document DOC-000146: Wound care note (synthetic)
WOUND CARE NOTE
Patient: Nico Ravensworth   MRN: MRN51596753

Location: sacrum
Stage: 2 (NPIAP)
Description: partial-thickness skin loss with exposed dermis.
Size: 2.0 x 3.9 x 0.4 cm.
Plan: offloading every 2 hours, foam dressing, nutrition consult.

Nutrition assessment · DOC-000145 · Viggo Ravensworth, RD (dietitian) · Fri Oct 30, 2026 02:52 PM

Cited facts from this note (5)
fat_loss
none · cited p. 1, line 7 · confidence 0.90
Show source for fat_loss
… MRN: MRN51596753 Context: acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. Assessment: well nourished; no malnutrition identified.
fluid_accumulation
none · cited p. 1, line 7 · confidence 0.90
Show source for fluid_accumulation
… e: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. Assessment: well nourished; no malnutrition identified.
intake_pct
100 · cited p. 1, line 5 · confidence 0.90
Show source for intake_pct
NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nico Ravensworth MRN: MRN51596753 Context: acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. …
muscle_loss
none · cited p. 1, line 7 · confidence 0.90
Show source for muscle_loss
… acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation. Assessment: well nourished; no malnutrition identified.
nutrition_context
acute · cited p. 1, line 4 · confidence 0.95
Show source for nutrition_context
NUTRITION ASSESSMENT (Registered Dietitian) Patient: Nico Ravensworth MRN: MRN51596753 Context: acute illness Intake: eating 100% of meals. Weight history: weight stable over the past 3 months. Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle was …
Source document DOC-000145: Nutrition assessment (synthetic)
NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Nico Ravensworth   MRN: MRN51596753

Context: acute illness
Intake: eating 100% of meals.
Weight history: weight stable over the past 3 months.
Nutrition-focused physical exam: no loss of subcutaneous fat; no muscle wasting; no fluid accumulation.
Assessment: well nourished; no malnutrition identified.

Progress note · DOC-000148 · Dr. Greta Kowalczyk (resident) · Sat Oct 31, 2026 08:52 AM

Source document DOC-000148: Progress note (synthetic)
PROGRESS NOTE (Resident)
Patient: Nico Ravensworth   MRN: MRN51596753   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. CHF: continue current management.
2. Malnourished: dietitian following.
3. Hyponatremia: trend sodium.
4. Anemia: trend hemoglobin.
5. Stage 4 sacral pressure ulcer: wound care following, offloading.

Resident: Dr. Greta Kowalczyk   Attending cosign: completed

Discharge summary · DOC-000149 · Dr. Jalen Carrow (attending) · Thu Nov 05, 2026 12:42 PM

Source document DOC-000149: Discharge summary (synthetic)
DISCHARGE SUMMARY
Patient: Nico Ravensworth   MRN: MRN51596753
Admitted 2026-10-29; discharged 2026-11-05.

Discharge diagnoses:
- malnourished
- CHF
- hyponatremia
- anemia
- stage 4 sacral pressure ulcer

Disposition: home with follow-up.