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-00048: Vera Quillan

47M · MRN24926371 · Hospital Medicine · admitted Wed Nov 11, 2026 10:35 PM · in hospital · attending Dr. Rosalind Quillan · resident Dr. Elena Nakashima · 179 cm, 70.8 kg

Documented diagnoses (current)

Principal: “urinary tract infection” · N39.0 Urinary tract infection, site not specified
“malnutrition” · E46 Unspecified protein-calorie malnutrition
“anemia” · D64.9 Anemia, unspecified
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications
“hyperlipidemia” · E78.5 Hyperlipidemia, unspecified
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 690 Kidney and urinary tract infections without MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 690.

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=1.056, t.ratio_s1=1.5, creat_rise_48h=0.06, 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=1.056, t.ratio_s3=3.0, creat_peak=1.13, 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=1.056, 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=0.06, 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

Specificity gap

Documented “anemia” (D64.9); criteria support the more specific Acute blood loss anemia (D62).

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=10.4, 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=2.7, t.drop_major=2.0, prbc_units=2, t.prbc_major=2	true
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=True	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=311, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=82.4, egfr_late=86.1	86.1
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=82.4, t.g2=60, egfr_late=86.1	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=86.1, 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=82.4, egfr_late=86.1, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=86.1, t.g2=60	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

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=136.0, t.profound=125, t.moderate=130, t.low=135	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=136.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, t.low=135	true

Malnutrition

Criteria met

Specificity gap

Documented “malnutrition” (E46); criteria support the more specific 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=70.0, t.a_sev_intake_pct=50, intake_days=14.0, t.a_sev_intake_days=5	false
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=70.0, t.a_mod_intake_pct=75, intake_days=14.0, t.a_mod_intake_days=7	true
derived: a_sev_wt	`(wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5)`	wt_loss_days=30.0, wt_loss_pct=5.3	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=5.3	true
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=70.0, t.c_intake_pct=75, intake_days=14.0, t.c_intake_days=30	false
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=70.0, t.c_intake_pct=75, intake_days=14.0, t.c_intake_days=30	false
derived: c_sev_wt	`(wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20)`	wt_loss_days=30.0, wt_loss_pct=5.3	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=5.3	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=70.0, wt_loss_pct=5.3, 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=47, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=22.1, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=22.1, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=22.1, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=22.1, 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=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)
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=37.6, 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=86.0, 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=10.83, t.wbc_hi=12, wbc_min_48h=9.09, 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=234.0	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=0.55	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=1.13	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=1.07	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 (18)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001643	Thu Nov 27, 2025 09:15 AM	creatinine	1.11 mg/dL
LAB-001644	Mon Oct 05, 2026 10:05 AM	creatinine	1.07 mg/dL
LAB-001645	Wed Nov 11, 2026 11:35 PM	creatinine	1.07 mg/dL
LAB-001648	Wed Nov 11, 2026 11:35 PM	sodium	136.0 mmol/L
LAB-001651	Wed Nov 11, 2026 11:35 PM	hemoglobin	13.13 g/dL
LAB-001654	Wed Nov 11, 2026 11:35 PM	wbc	10.83 x10^3/uL
LAB-001655	Wed Nov 11, 2026 11:35 PM	platelets	235.0 x10^3/uL
LAB-001660	Wed Nov 11, 2026 11:35 PM	bilirubin	0.55 mg/dL
LAB-001646	Thu Nov 12, 2026 05:00 AM	creatinine	1.12 mg/dL
LAB-001649	Thu Nov 12, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001652	Thu Nov 12, 2026 05:00 AM	hemoglobin	11.49 g/dL
LAB-001656	Thu Nov 12, 2026 05:00 AM	wbc	9.49 x10^3/uL
LAB-001657	Thu Nov 12, 2026 05:00 AM	platelets	234.0 x10^3/uL
LAB-001647	Fri Nov 13, 2026 05:00 AM	creatinine	1.13 mg/dL
LAB-001650	Fri Nov 13, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-001653	Fri Nov 13, 2026 05:00 AM	hemoglobin	10.4 g/dL
LAB-001658	Fri Nov 13, 2026 05:00 AM	wbc	9.09 x10^3/uL
LAB-001659	Fri Nov 13, 2026 05:00 AM	platelets	273.0 x10^3/uL

Vitals (36)

Vitals
Row	When	Kind	Value	Detail
VIT-004759	Wed Nov 11, 2026 10:55 PM	spo2	95.0	room air
VIT-004760	Wed Nov 11, 2026 10:55 PM	rr	14.0
VIT-004771	Wed Nov 11, 2026 10:55 PM	temp_c	37.6
VIT-004772	Wed Nov 11, 2026 10:55 PM	hr	74.0
VIT-004773	Wed Nov 11, 2026 10:55 PM	map	75.0
VIT-004774	Wed Nov 11, 2026 10:55 PM	gcs	15.0
VIT-004761	Thu Nov 12, 2026 06:55 AM	spo2	95.0	room air
VIT-004762	Thu Nov 12, 2026 06:55 AM	rr	18.0
VIT-004775	Thu Nov 12, 2026 06:55 AM	temp_c	36.8
VIT-004776	Thu Nov 12, 2026 06:55 AM	hr	77.0
VIT-004777	Thu Nov 12, 2026 06:55 AM	map	92.0
VIT-004778	Thu Nov 12, 2026 06:55 AM	gcs	15.0
VIT-004763	Thu Nov 12, 2026 02:55 PM	spo2	96.0	room air
VIT-004764	Thu Nov 12, 2026 02:55 PM	rr	19.0
VIT-004779	Thu Nov 12, 2026 02:55 PM	temp_c	37.2
VIT-004780	Thu Nov 12, 2026 02:55 PM	hr	86.0
VIT-004781	Thu Nov 12, 2026 02:55 PM	map	89.0
VIT-004782	Thu Nov 12, 2026 02:55 PM	gcs	15.0
VIT-004765	Thu Nov 12, 2026 10:55 PM	spo2	95.0	room air
VIT-004766	Thu Nov 12, 2026 10:55 PM	rr	14.0
VIT-004783	Thu Nov 12, 2026 10:55 PM	temp_c	36.8
VIT-004784	Thu Nov 12, 2026 10:55 PM	hr	73.0
VIT-004785	Thu Nov 12, 2026 10:55 PM	map	76.0
VIT-004786	Thu Nov 12, 2026 10:55 PM	gcs	15.0
VIT-004767	Fri Nov 13, 2026 06:55 AM	spo2	95.0	room air
VIT-004768	Fri Nov 13, 2026 06:55 AM	rr	20.0
VIT-004787	Fri Nov 13, 2026 06:55 AM	temp_c	37.3
VIT-004788	Fri Nov 13, 2026 06:55 AM	hr	84.0
VIT-004789	Fri Nov 13, 2026 06:55 AM	map	86.0
VIT-004790	Fri Nov 13, 2026 06:55 AM	gcs	15.0
VIT-004769	Fri Nov 13, 2026 02:55 PM	spo2	95.0	room air
VIT-004770	Fri Nov 13, 2026 02:55 PM	rr	20.0
VIT-004791	Fri Nov 13, 2026 02:55 PM	temp_c	37.1
VIT-004792	Fri Nov 13, 2026 02:55 PM	hr	83.0
VIT-004793	Fri Nov 13, 2026 02:55 PM	map	79.0
VIT-004794	Fri Nov 13, 2026 02:55 PM	gcs	15.0

Medications, orders, echo, history (5)

MED-000170 11-11 23:35 cefepime per protocol IV
MED-000171 11-12 05:00 cefepime per protocol IV
MED-000172 11-13 05:00 piperacillin-tazobactam per protocol IV
ORD-000039 11-11 23:05 blood_culture: blood cultures x2
ORD-000040 11-12 09:00 transfusion_prbc: transfuse PRBC

Notes

History and physical · DOC-000167 · Dr. Elena Nakashima (resident) · Thu Nov 12, 2026 01:35 AM

Cited facts from this note (2)

bleeding_source: black tarry stools · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… : 47-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime. Hospital course complicated by black tarry stools. Past medical history: type 2 diabetes, hyperlipidemia, GERD. Review of systems otherwise negative. Exam: Lungs: scattered crackles at the bases, no distress. …
infection_source: urinary tract infection · cited p. 1, line 5 · confidence 0.85

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… RN24926371 Admitted: 2026-11-11 22:35 Service: Hospital Medicine Attending: Dr. Rosalind Quillan History of present illness: 47-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime. Hospital course complicated by black tarry stools. Past medical history: type 2 diabet …

Source document DOC-000167: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Vera Quillan   MRN: MRN24926371   Admitted: 2026-11-11 22:35
Service: Hospital Medicine   Attending: Dr. Rosalind Quillan

History of present illness: 47-year-old man admitted with urinary tract infection. Urinalysis with pyuria; treated for acute pyelonephritis with cefepime. Hospital course complicated by black tarry stools.
Past medical history: type 2 diabetes, hyperlipidemia, GERD.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Urinary tract infection: antibiotics.

Nutrition assessment · DOC-000166 · Dario Larkspur, RD (dietitian) · Fri Nov 13, 2026 01:35 AM

Cited facts from this note (8)

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

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… ontext: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

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… e 70% of needs for 14 days. Weight history: 5.3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
intake_days: 14 · cited p. 1, line 5 · confidence 0.95

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NUTRITION ASSESSMENT (Registered Dietitian) Patient: Vera Quillan MRN: MRN24926371 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Rec …
intake_pct: 70 · cited p. 1, line 5 · confidence 0.95

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NUTRITION ASSESSMENT (Registered Dietitian) Patient: Vera Quillan MRN: MRN24926371 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.3% 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

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… stimated energy intake 70% of needs for 14 days. Weight history: 5.3% 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

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NUTRITION ASSESSMENT (Registered Dietitian) Patient: Vera Quillan MRN: MRN24926371 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.3% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutan …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

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… egistered Dietitian) Patient: Vera Quillan MRN: MRN24926371 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.3% 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: 5.3 · cited p. 1, line 6 · confidence 0.95

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… egistered Dietitian) Patient: Vera Quillan MRN: MRN24926371 Context: acute illness Intake: estimated energy intake 70% of needs for 14 days. Weight history: 5.3% 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-000166: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Vera Quillan   MRN: MRN24926371

Context: acute illness
Intake: estimated energy intake 70% of needs for 14 days.
Weight history: 5.3% 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-000168 · Dr. Elena Nakashima (resident) · Fri Nov 13, 2026 01:55 PM · awaiting cosign

Source document DOC-000168: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Vera Quillan   MRN: MRN24926371   Hospital day 2

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Urinary tract infection: continue current management.
2. Malnutrition: dietitian following.
3. Anemia: trend hemoglobin.

Resident: Dr. Elena Nakashima   Attending cosign: pending