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-00044: Nico Greaves

76F · MRN55221056 · Hospital Medicine · admitted Fri Nov 06, 2026 06:09 PM · discharged Thu Nov 12, 2026 12:53 PM · attending Dr. Gideon Zeller · resident Dr. Greta Kowalczyk · 156 cm, 69.9 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“chronic kidney disease” · N18.9 Chronic kidney disease, unspecified
“renal insufficiency” · N28.9 Disorder of kidney and ureter, unspecified (renal insufficiency)
“hypoxia” · R09.02 Hypoxemia
“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 193.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria met

Specificity gap

Documented “renal insufficiency” (N28.9); criteria support the more specific Acute kidney injury (KDIGO stage 2) (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=2.282, t.ratio_s1=1.5, creat_rise_48h=0.55, 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=2.282, t.ratio_s3=3.0, creat_peak=2.51, 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=2.282, 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=0.55, 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=12.43, 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=0.2, 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=0.2, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=12.43, 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 3a (N18.31).

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=285, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=51.0, egfr_late=52.1	52.1
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=51.0, t.g2=60, egfr_late=52.1	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=52.1, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G3a
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=51.0, egfr_late=52.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=52.1, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G3a	true

Heart failure

Clinical judgement required

No gap

Not documented; 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=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=True	1
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=1, 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=1	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)
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 not met

No gap

Not documented and not supported.

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=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)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=76, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=28.7, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=28.7, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=28.7, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=28.7, 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 met

Specificity gap

Documented “hypoxia” (R09.02); criteria support the more specific Acute respiratory failure with hypoxia (J96.01).

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=83.0, 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=83.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	true
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=29.0, t.rr_distress=28, wob_increased=True, adv_resp_support=False	true
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=True	false
outcome: met	`hypoxemia and distress`	hypoxemia=True, distress=True	true

Sepsis

Criteria met

No gap

Criteria support Sepsis (Sepsis-3); not documented (this rule does not prompt for an undocumented diagnosis).

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=37.5, 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=90.0, 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=29.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	true
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=9.24, t.wbc_hi=12, wbc_min_48h=7.49, 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=True, sirs_wbc=False	1
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=179.0	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=0.57	0
derived: sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`	norepi_max_48h=0.0, map_min_48h=75.0	0
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=2.51	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=1.1	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=2, sofa_renal_baseline=0	2
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=2, t.sofa_delta=2	true
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, sirs_count=1, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=True, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=True	false
outcome: septic_shock	`shock`	shock=False	false
outcome: both	`sepsis3 and sepsis2`	sepsis3=True, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=True	true

Structured data

Labs (38)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001499	Mon Nov 24, 2025 09:15 AM	creatinine	1.12 mg/dL
LAB-001500	Sun Sep 06, 2026 10:05 AM	creatinine	1.1 mg/dL
LAB-001501	Fri Nov 06, 2026 07:09 PM	creatinine	1.96 mg/dL
LAB-001508	Fri Nov 06, 2026 07:09 PM	sodium	139.0 mmol/L
LAB-001515	Fri Nov 06, 2026 07:09 PM	hemoglobin	12.59 g/dL
LAB-001522	Fri Nov 06, 2026 07:09 PM	wbc	7.49 x10^3/uL
LAB-001523	Fri Nov 06, 2026 07:09 PM	platelets	179.0 x10^3/uL
LAB-001536	Fri Nov 06, 2026 07:09 PM	bilirubin	0.57 mg/dL
LAB-001502	Sat Nov 07, 2026 05:00 AM	creatinine	2.51 mg/dL
LAB-001509	Sat Nov 07, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001516	Sat Nov 07, 2026 05:00 AM	hemoglobin	12.43 g/dL
LAB-001524	Sat Nov 07, 2026 05:00 AM	wbc	9.24 x10^3/uL
LAB-001525	Sat Nov 07, 2026 05:00 AM	platelets	237.0 x10^3/uL
LAB-001503	Sun Nov 08, 2026 05:00 AM	creatinine	2.26 mg/dL
LAB-001510	Sun Nov 08, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-001517	Sun Nov 08, 2026 05:00 AM	hemoglobin	12.62 g/dL
LAB-001526	Sun Nov 08, 2026 05:00 AM	wbc	8.53 x10^3/uL
LAB-001527	Sun Nov 08, 2026 05:00 AM	platelets	254.0 x10^3/uL
LAB-001504	Mon Nov 09, 2026 05:00 AM	creatinine	1.88 mg/dL
LAB-001511	Mon Nov 09, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-001518	Mon Nov 09, 2026 05:00 AM	hemoglobin	12.46 g/dL
LAB-001528	Mon Nov 09, 2026 05:00 AM	wbc	10.42 x10^3/uL
LAB-001529	Mon Nov 09, 2026 05:00 AM	platelets	273.0 x10^3/uL
LAB-001505	Tue Nov 10, 2026 05:00 AM	creatinine	1.55 mg/dL
LAB-001512	Tue Nov 10, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001519	Tue Nov 10, 2026 05:00 AM	hemoglobin	12.73 g/dL
LAB-001530	Tue Nov 10, 2026 05:00 AM	wbc	8.04 x10^3/uL
LAB-001531	Tue Nov 10, 2026 05:00 AM	platelets	309.0 x10^3/uL
LAB-001506	Wed Nov 11, 2026 05:00 AM	creatinine	1.38 mg/dL
LAB-001513	Wed Nov 11, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-001520	Wed Nov 11, 2026 05:00 AM	hemoglobin	12.73 g/dL
LAB-001532	Wed Nov 11, 2026 05:00 AM	wbc	7.65 x10^3/uL
LAB-001533	Wed Nov 11, 2026 05:00 AM	platelets	213.0 x10^3/uL
LAB-001507	Thu Nov 12, 2026 05:00 AM	creatinine	1.25 mg/dL
LAB-001514	Thu Nov 12, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001521	Thu Nov 12, 2026 05:00 AM	hemoglobin	12.43 g/dL
LAB-001534	Thu Nov 12, 2026 05:00 AM	wbc	9.94 x10^3/uL
LAB-001535	Thu Nov 12, 2026 05:00 AM	platelets	177.0 x10^3/uL

Vitals (134)

Vitals
Row	When	Kind	Value	Detail
VIT-004306	Fri Nov 06, 2026 06:29 PM	spo2	83.0	room air
VIT-004307	Fri Nov 06, 2026 06:29 PM	rr	29.0
VIT-004360	Fri Nov 06, 2026 06:29 PM	temp_c	36.5
VIT-004361	Fri Nov 06, 2026 06:29 PM	hr	74.0
VIT-004362	Fri Nov 06, 2026 06:29 PM	map	75.0
VIT-004363	Fri Nov 06, 2026 06:29 PM	gcs	15.0
VIT-004308	Fri Nov 06, 2026 06:39 PM	o2_lpm	5.0	nasal cannula
VIT-004298	Sat Nov 07, 2026 12:09 AM	urine_ml_6h	461.3
VIT-004309	Sat Nov 07, 2026 02:29 AM	spo2	95.0	nasal cannula
VIT-004310	Sat Nov 07, 2026 02:29 AM	rr	22.0
VIT-004311	Sat Nov 07, 2026 02:29 AM	o2_lpm	4.0	nasal cannula
VIT-004364	Sat Nov 07, 2026 02:29 AM	temp_c	37.5
VIT-004365	Sat Nov 07, 2026 02:29 AM	hr	70.0
VIT-004366	Sat Nov 07, 2026 02:29 AM	map	86.0
VIT-004367	Sat Nov 07, 2026 02:29 AM	gcs	15.0
VIT-004299	Sat Nov 07, 2026 06:09 AM	urine_ml_6h	176.1
VIT-004312	Sat Nov 07, 2026 10:29 AM	spo2	94.0	nasal cannula
VIT-004313	Sat Nov 07, 2026 10:29 AM	rr	21.0
VIT-004314	Sat Nov 07, 2026 10:29 AM	o2_lpm	3.0	nasal cannula
VIT-004368	Sat Nov 07, 2026 10:29 AM	temp_c	37.2
VIT-004369	Sat Nov 07, 2026 10:29 AM	hr	85.0
VIT-004370	Sat Nov 07, 2026 10:29 AM	map	82.0
VIT-004371	Sat Nov 07, 2026 10:29 AM	gcs	15.0
VIT-004300	Sat Nov 07, 2026 12:09 PM	urine_ml_6h	176.1
VIT-004301	Sat Nov 07, 2026 06:09 PM	urine_ml_6h	176.1
VIT-004315	Sat Nov 07, 2026 06:29 PM	spo2	95.0	nasal cannula
VIT-004316	Sat Nov 07, 2026 06:29 PM	rr	25.0
VIT-004317	Sat Nov 07, 2026 06:29 PM	o2_lpm	2.0	nasal cannula
VIT-004372	Sat Nov 07, 2026 06:29 PM	temp_c	37.3
VIT-004373	Sat Nov 07, 2026 06:29 PM	hr	90.0
VIT-004374	Sat Nov 07, 2026 06:29 PM	map	83.0
VIT-004375	Sat Nov 07, 2026 06:29 PM	gcs	15.0
VIT-004302	Sun Nov 08, 2026 12:09 AM	urine_ml_6h	461.3
VIT-004318	Sun Nov 08, 2026 02:29 AM	spo2	91.0	nasal cannula
VIT-004319	Sun Nov 08, 2026 02:29 AM	rr	26.0
VIT-004320	Sun Nov 08, 2026 02:29 AM	o2_lpm	3.0	nasal cannula
VIT-004376	Sun Nov 08, 2026 02:29 AM	temp_c	37.2
VIT-004377	Sun Nov 08, 2026 02:29 AM	hr	72.0
VIT-004378	Sun Nov 08, 2026 02:29 AM	map	91.0
VIT-004379	Sun Nov 08, 2026 02:29 AM	gcs	15.0
VIT-004303	Sun Nov 08, 2026 06:09 AM	urine_ml_6h	461.3
VIT-004321	Sun Nov 08, 2026 10:29 AM	spo2	92.0	nasal cannula
VIT-004322	Sun Nov 08, 2026 10:29 AM	rr	24.0
VIT-004323	Sun Nov 08, 2026 10:29 AM	o2_lpm	3.0	nasal cannula
VIT-004380	Sun Nov 08, 2026 10:29 AM	temp_c	37.5
VIT-004381	Sun Nov 08, 2026 10:29 AM	hr	68.0
VIT-004382	Sun Nov 08, 2026 10:29 AM	map	90.0
VIT-004383	Sun Nov 08, 2026 10:29 AM	gcs	15.0
VIT-004304	Sun Nov 08, 2026 12:09 PM	urine_ml_6h	461.3
VIT-004305	Sun Nov 08, 2026 06:09 PM	urine_ml_6h	461.3
VIT-004324	Sun Nov 08, 2026 06:29 PM	spo2	91.0	nasal cannula
VIT-004325	Sun Nov 08, 2026 06:29 PM	rr	20.0
VIT-004326	Sun Nov 08, 2026 06:29 PM	o2_lpm	3.0	nasal cannula
VIT-004384	Sun Nov 08, 2026 06:29 PM	temp_c	36.5
VIT-004385	Sun Nov 08, 2026 06:29 PM	hr	86.0
VIT-004386	Sun Nov 08, 2026 06:29 PM	map	77.0
VIT-004387	Sun Nov 08, 2026 06:29 PM	gcs	15.0
VIT-004327	Mon Nov 09, 2026 02:29 AM	spo2	92.0	nasal cannula
VIT-004328	Mon Nov 09, 2026 02:29 AM	rr	24.0
VIT-004329	Mon Nov 09, 2026 02:29 AM	o2_lpm	4.0	nasal cannula
VIT-004388	Mon Nov 09, 2026 02:29 AM	temp_c	37.3
VIT-004389	Mon Nov 09, 2026 02:29 AM	hr	70.0
VIT-004390	Mon Nov 09, 2026 02:29 AM	map	85.0
VIT-004391	Mon Nov 09, 2026 02:29 AM	gcs	15.0
VIT-004330	Mon Nov 09, 2026 10:29 AM	spo2	95.0	nasal cannula
VIT-004331	Mon Nov 09, 2026 10:29 AM	rr	26.0
VIT-004332	Mon Nov 09, 2026 10:29 AM	o2_lpm	2.0	nasal cannula
VIT-004392	Mon Nov 09, 2026 10:29 AM	temp_c	36.9
VIT-004393	Mon Nov 09, 2026 10:29 AM	hr	74.0
VIT-004394	Mon Nov 09, 2026 10:29 AM	map	83.0
VIT-004395	Mon Nov 09, 2026 10:29 AM	gcs	15.0
VIT-004333	Mon Nov 09, 2026 06:29 PM	spo2	91.0	nasal cannula
VIT-004334	Mon Nov 09, 2026 06:29 PM	rr	21.0
VIT-004335	Mon Nov 09, 2026 06:29 PM	o2_lpm	2.0	nasal cannula
VIT-004396	Mon Nov 09, 2026 06:29 PM	temp_c	37.0
VIT-004397	Mon Nov 09, 2026 06:29 PM	hr	87.0
VIT-004398	Mon Nov 09, 2026 06:29 PM	map	80.0
VIT-004399	Mon Nov 09, 2026 06:29 PM	gcs	15.0
VIT-004336	Tue Nov 10, 2026 02:29 AM	spo2	92.0	nasal cannula
VIT-004337	Tue Nov 10, 2026 02:29 AM	rr	25.0
VIT-004338	Tue Nov 10, 2026 02:29 AM	o2_lpm	2.0	nasal cannula
VIT-004400	Tue Nov 10, 2026 02:29 AM	temp_c	37.2
VIT-004401	Tue Nov 10, 2026 02:29 AM	hr	84.0
VIT-004402	Tue Nov 10, 2026 02:29 AM	map	87.0
VIT-004403	Tue Nov 10, 2026 02:29 AM	gcs	15.0
VIT-004339	Tue Nov 10, 2026 10:29 AM	spo2	94.0	nasal cannula
VIT-004340	Tue Nov 10, 2026 10:29 AM	rr	23.0
VIT-004341	Tue Nov 10, 2026 10:29 AM	o2_lpm	4.0	nasal cannula
VIT-004404	Tue Nov 10, 2026 10:29 AM	temp_c	37.0
VIT-004405	Tue Nov 10, 2026 10:29 AM	hr	72.0
VIT-004406	Tue Nov 10, 2026 10:29 AM	map	82.0
VIT-004407	Tue Nov 10, 2026 10:29 AM	gcs	15.0
VIT-004342	Tue Nov 10, 2026 06:29 PM	spo2	94.0	nasal cannula
VIT-004343	Tue Nov 10, 2026 06:29 PM	rr	22.0
VIT-004344	Tue Nov 10, 2026 06:29 PM	o2_lpm	3.0	nasal cannula
VIT-004408	Tue Nov 10, 2026 06:29 PM	temp_c	37.1
VIT-004409	Tue Nov 10, 2026 06:29 PM	hr	78.0
VIT-004410	Tue Nov 10, 2026 06:29 PM	map	74.0
VIT-004411	Tue Nov 10, 2026 06:29 PM	gcs	15.0
VIT-004345	Wed Nov 11, 2026 02:29 AM	spo2	94.0	nasal cannula
VIT-004346	Wed Nov 11, 2026 02:29 AM	rr	23.0
VIT-004347	Wed Nov 11, 2026 02:29 AM	o2_lpm	3.0	nasal cannula
VIT-004412	Wed Nov 11, 2026 02:29 AM	temp_c	37.5
VIT-004413	Wed Nov 11, 2026 02:29 AM	hr	76.0
VIT-004414	Wed Nov 11, 2026 02:29 AM	map	89.0
VIT-004415	Wed Nov 11, 2026 02:29 AM	gcs	15.0
VIT-004348	Wed Nov 11, 2026 10:29 AM	spo2	94.0	nasal cannula
VIT-004349	Wed Nov 11, 2026 10:29 AM	rr	22.0
VIT-004350	Wed Nov 11, 2026 10:29 AM	o2_lpm	2.0	nasal cannula
VIT-004416	Wed Nov 11, 2026 10:29 AM	temp_c	37.0
VIT-004417	Wed Nov 11, 2026 10:29 AM	hr	84.0
VIT-004418	Wed Nov 11, 2026 10:29 AM	map	74.0
VIT-004419	Wed Nov 11, 2026 10:29 AM	gcs	15.0
VIT-004351	Wed Nov 11, 2026 06:29 PM	spo2	94.0	nasal cannula
VIT-004352	Wed Nov 11, 2026 06:29 PM	rr	22.0
VIT-004353	Wed Nov 11, 2026 06:29 PM	o2_lpm	2.0	nasal cannula
VIT-004420	Wed Nov 11, 2026 06:29 PM	temp_c	37.3
VIT-004421	Wed Nov 11, 2026 06:29 PM	hr	90.0
VIT-004422	Wed Nov 11, 2026 06:29 PM	map	89.0
VIT-004423	Wed Nov 11, 2026 06:29 PM	gcs	15.0
VIT-004354	Thu Nov 12, 2026 02:29 AM	spo2	93.0	nasal cannula
VIT-004355	Thu Nov 12, 2026 02:29 AM	rr	23.0
VIT-004356	Thu Nov 12, 2026 02:29 AM	o2_lpm	2.0	nasal cannula
VIT-004424	Thu Nov 12, 2026 02:29 AM	temp_c	36.8
VIT-004425	Thu Nov 12, 2026 02:29 AM	hr	68.0
VIT-004426	Thu Nov 12, 2026 02:29 AM	map	86.0
VIT-004427	Thu Nov 12, 2026 02:29 AM	gcs	15.0
VIT-004357	Thu Nov 12, 2026 10:29 AM	spo2	95.0	nasal cannula
VIT-004358	Thu Nov 12, 2026 10:29 AM	rr	26.0
VIT-004359	Thu Nov 12, 2026 10:29 AM	o2_lpm	3.0	nasal cannula
VIT-004428	Thu Nov 12, 2026 10:29 AM	temp_c	36.8
VIT-004429	Thu Nov 12, 2026 10:29 AM	hr	77.0
VIT-004430	Thu Nov 12, 2026 10:29 AM	map	80.0
VIT-004431	Thu Nov 12, 2026 10:29 AM	gcs	15.0

Medications, orders, echo, history (4)

MED-000161 11-06 19:09 piperacillin-tazobactam per protocol IV
MED-000162 11-07 05:00 piperacillin-tazobactam per protocol IV
MED-000163 11-08 05:00 ceftriaxone per protocol IV
ORD-000036 11-06 18:39 blood_culture: blood cultures x2

Notes

History and physical · DOC-000151 · Dr. Greta Kowalczyk (resident) · Fri Nov 06, 2026 09:09 PM

Cited facts from this note (2)

infection_source: left 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: 76-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: none significant. Review of systems otherwise negative. Exam: Lungs: increased work of bre …
work_of_breathing: increased · cited p. 1, line 8 · confidence 0.90

Show source for work_of_breathing

… lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: none significant. Review of systems otherwise negative. Exam: Lungs: increased work of breathing with accessory muscle use. Assessment and plan: 1. Community-acquired pneumonia: antibiotics. 2. Chronic kidney disease: renally dose medications.

Source document DOC-000151: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Nico Greaves   MRN: MRN55221056   Admitted: 2026-11-06 18:09
Service: Hospital Medicine   Attending: Dr. Gideon Zeller

History of present illness: 76-year-old woman admitted with community-acquired pneumonia. Chest x-ray shows left lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: none significant.
Review of systems otherwise negative.
Exam: Lungs: increased work of breathing with accessory muscle use.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.
2. Chronic kidney disease: renally dose medications.

Nutrition assessment · DOC-000150 · Dario Larkspur, RD (dietitian) · Sun Nov 08, 2026 12:09 AM

Cited facts from this note (5)

fat_loss: none · cited p. 1, line 7 · confidence 0.90

Show source for fat_loss

… MRN: MRN55221056 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 Greaves MRN: MRN55221056 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 Greaves MRN: MRN55221056 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-000150: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Nico Greaves   MRN: MRN55221056

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-000152 · Dr. Greta Kowalczyk (resident) · Sun Nov 08, 2026 07:09 PM

Source document DOC-000152: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Nico Greaves   MRN: MRN55221056   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. Renal insufficiency: trend creatinine, avoid nephrotoxins.
3. Hypoxia: supplemental oxygen, wean as tolerated.
4. Hyponatremia: trend sodium.

Resident: Dr. Greta Kowalczyk   Attending cosign: completed

Discharge summary · DOC-000153 · Dr. Gideon Zeller (attending) · Thu Nov 12, 2026 12:53 PM

Source document DOC-000153: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Nico Greaves   MRN: MRN55221056
Admitted 2026-11-06; discharged 2026-11-12.

Discharge diagnoses:
- community-acquired pneumonia
- chronic kidney disease
- renal insufficiency
- hypoxia
- hyponatremia

Disposition: home with follow-up.