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-00049: Ximena Vance

79M · MRN27659120 · Hospital Medicine · admitted Tue Nov 03, 2026 04:12 PM · discharged Sun Nov 08, 2026 03:05 PM · attending Dr. Wes Merriweather · resident Dr. Noor Halvorsen · 170 cm, 72.5 kg

Documented diagnoses (current)

Principal: “community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“acute kidney injury” · N17.9 Acute kidney failure, unspecified
“chronic systolic heart failure” · I50.22 Chronic systolic (congestive) heart failure
“acute blood loss anemia” · D62 Acute posthemorrhagic anemia
“stage 3 sacral pressure injury” · L89.153 Pressure ulcer of sacral region, stage 3

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

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

Clinical validation gap

Documented “acute kidney injury” (N17.9) but the criteria are not met: KDIGO creatinine and urine-output criteria not met.

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=1.044, 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=1.044, t.ratio_s3=3.0, creat_peak=0.71, 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=1.044, 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

Clinical validation gap

Documented “acute blood loss anemia” (D62) is more specific than the criteria support (Anemia (acute blood-loss criteria not met), D64.9).

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=11.44, 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=0.4, 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=0.4, 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)
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=220, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=94.1, egfr_late=94.6	94.6
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=94.1, t.g2=60, egfr_late=94.6	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=94.6, 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=94.1, egfr_late=94.6, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=94.6, t.g2=60	true

Heart failure

Criteria met

No gap

Supported as documented (I50.22).

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=33.0, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	false
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=False, np_elevated=False, new_o2=False	0
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=27.0, t.ref=40, t.pres=50	systolic
derived: improved	`coalesce(lvef_prior_min <= t.ref and lvef > t.ref and lvef - lvef_prior_min >= t.improved_rise, false)`	lvef_prior_min=unknown, t.ref=40, lvef=27.0, 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=0, hf_history=True	chronic
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=systolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=systolic, acuity=chronic	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=systolic, acuity=chronic	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=systolic, acuity=chronic	true

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=137.0, 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=137.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=137.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=137.0, t.low=135	true

Malnutrition

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

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=unknown, t.a_sev_intake_pct=50, intake_days=unknown, t.a_sev_intake_days=5	unknown
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=unknown, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7	unknown
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=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
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=unknown, wt_loss_pct=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown	0
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=unknown, a_sev_intake=unknown, a_sev_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_sev_wt=unknown	unknown
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=unknown, a_sev_intake=unknown, a_mod_intake=unknown, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_mod_intake=unknown, c_sev_wt=unknown, c_mod_wt=unknown	unknown
outcome: severe	`n_severe >= 2`	n_severe=unknown	unknown
outcome: moderate	`n_moderate >= 2`	n_moderate=unknown	unknown
outcome: one_characteristic	`n_moderate == 1`	n_moderate=unknown	unknown
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=unknown, n_assessed=0	false

Obesity

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule obesity v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=79, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=25.1, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=25.1, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=25.1, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=25.1, 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=sacral	true
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=37.5, t.t_hi=38, temp_min_48h=37.0, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=89.0, 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=10.8, t.wbc_hi=12, wbc_min_48h=7.15, 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=173.0	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=0.78	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=76.0	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=0.69	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=0.68	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=0, sofa_renal_baseline=0	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=True, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=True, sirs_count=0, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=False, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=True	false
outcome: septic_shock	`shock`	shock=False	false
outcome: both	`sepsis3 and sepsis2`	sepsis3=False, sepsis2=False	false
outcome: sepsis3_only	`sepsis3`	sepsis3=False	false
outcome: definitions_disagree	`sepsis2`	sepsis2=False	false
outcome: neither	`true`	—	true

Structured data

Labs (34)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001661	Mon Dec 22, 2025 09:15 AM	creatinine	0.69 mg/dL
LAB-001662	Fri Jul 31, 2026 10:05 AM	creatinine	0.68 mg/dL
LAB-001663	Tue Nov 03, 2026 05:12 PM	creatinine	0.68 mg/dL
LAB-001669	Tue Nov 03, 2026 05:12 PM	bnp	33.0 pg/mL
LAB-001670	Tue Nov 03, 2026 05:12 PM	sodium	138.0 mmol/L
LAB-001676	Tue Nov 03, 2026 05:12 PM	hemoglobin	11.84 g/dL
LAB-001682	Tue Nov 03, 2026 05:12 PM	wbc	7.61 x10^3/uL
LAB-001683	Tue Nov 03, 2026 05:12 PM	platelets	233.0 x10^3/uL
LAB-001694	Tue Nov 03, 2026 05:12 PM	bilirubin	0.78 mg/dL
LAB-001664	Wed Nov 04, 2026 05:00 AM	creatinine	0.69 mg/dL
LAB-001671	Wed Nov 04, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001677	Wed Nov 04, 2026 05:00 AM	hemoglobin	11.44 g/dL
LAB-001684	Wed Nov 04, 2026 05:00 AM	wbc	7.15 x10^3/uL
LAB-001685	Wed Nov 04, 2026 05:00 AM	platelets	289.0 x10^3/uL
LAB-001665	Thu Nov 05, 2026 05:00 AM	creatinine	0.68 mg/dL
LAB-001672	Thu Nov 05, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001678	Thu Nov 05, 2026 05:00 AM	hemoglobin	11.84 g/dL
LAB-001686	Thu Nov 05, 2026 05:00 AM	wbc	10.8 x10^3/uL
LAB-001687	Thu Nov 05, 2026 05:00 AM	platelets	173.0 x10^3/uL
LAB-001666	Fri Nov 06, 2026 05:00 AM	creatinine	0.71 mg/dL
LAB-001673	Fri Nov 06, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001679	Fri Nov 06, 2026 05:00 AM	hemoglobin	11.44 g/dL
LAB-001688	Fri Nov 06, 2026 05:00 AM	wbc	9.94 x10^3/uL
LAB-001689	Fri Nov 06, 2026 05:00 AM	platelets	275.0 x10^3/uL
LAB-001667	Sat Nov 07, 2026 05:00 AM	creatinine	0.71 mg/dL
LAB-001674	Sat Nov 07, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001680	Sat Nov 07, 2026 05:00 AM	hemoglobin	11.84 g/dL
LAB-001690	Sat Nov 07, 2026 05:00 AM	wbc	8.55 x10^3/uL
LAB-001691	Sat Nov 07, 2026 05:00 AM	platelets	215.0 x10^3/uL
LAB-001668	Sun Nov 08, 2026 05:00 AM	creatinine	0.68 mg/dL
LAB-001675	Sun Nov 08, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001681	Sun Nov 08, 2026 05:00 AM	hemoglobin	11.44 g/dL
LAB-001692	Sun Nov 08, 2026 05:00 AM	wbc	6.45 x10^3/uL
LAB-001693	Sun Nov 08, 2026 05:00 AM	platelets	236.0 x10^3/uL

Vitals (90)

Vitals
Row	When	Kind	Value	Detail
VIT-004795	Tue Nov 03, 2026 04:32 PM	spo2	96.0	room air
VIT-004796	Tue Nov 03, 2026 04:32 PM	rr	14.0
VIT-004825	Tue Nov 03, 2026 04:32 PM	temp_c	37.5
VIT-004826	Tue Nov 03, 2026 04:32 PM	hr	70.0
VIT-004827	Tue Nov 03, 2026 04:32 PM	map	86.0
VIT-004828	Tue Nov 03, 2026 04:32 PM	gcs	15.0
VIT-004797	Wed Nov 04, 2026 12:32 AM	spo2	95.0	room air
VIT-004798	Wed Nov 04, 2026 12:32 AM	rr	18.0
VIT-004829	Wed Nov 04, 2026 12:32 AM	temp_c	37.1
VIT-004830	Wed Nov 04, 2026 12:32 AM	hr	68.0
VIT-004831	Wed Nov 04, 2026 12:32 AM	map	83.0
VIT-004832	Wed Nov 04, 2026 12:32 AM	gcs	15.0
VIT-004799	Wed Nov 04, 2026 08:32 AM	spo2	99.0	room air
VIT-004800	Wed Nov 04, 2026 08:32 AM	rr	16.0
VIT-004833	Wed Nov 04, 2026 08:32 AM	temp_c	37.0
VIT-004834	Wed Nov 04, 2026 08:32 AM	hr	78.0
VIT-004835	Wed Nov 04, 2026 08:32 AM	map	76.0
VIT-004836	Wed Nov 04, 2026 08:32 AM	gcs	15.0
VIT-004801	Wed Nov 04, 2026 04:32 PM	spo2	94.0	room air
VIT-004802	Wed Nov 04, 2026 04:32 PM	rr	19.0
VIT-004837	Wed Nov 04, 2026 04:32 PM	temp_c	37.4
VIT-004838	Wed Nov 04, 2026 04:32 PM	hr	86.0
VIT-004839	Wed Nov 04, 2026 04:32 PM	map	84.0
VIT-004840	Wed Nov 04, 2026 04:32 PM	gcs	15.0
VIT-004803	Thu Nov 05, 2026 12:32 AM	spo2	94.0	room air
VIT-004804	Thu Nov 05, 2026 12:32 AM	rr	19.0
VIT-004841	Thu Nov 05, 2026 12:32 AM	temp_c	37.0
VIT-004842	Thu Nov 05, 2026 12:32 AM	hr	89.0
VIT-004843	Thu Nov 05, 2026 12:32 AM	map	92.0
VIT-004844	Thu Nov 05, 2026 12:32 AM	gcs	15.0
VIT-004805	Thu Nov 05, 2026 08:32 AM	spo2	96.0	room air
VIT-004806	Thu Nov 05, 2026 08:32 AM	rr	17.0
VIT-004845	Thu Nov 05, 2026 08:32 AM	temp_c	37.5
VIT-004846	Thu Nov 05, 2026 08:32 AM	hr	81.0
VIT-004847	Thu Nov 05, 2026 08:32 AM	map	80.0
VIT-004848	Thu Nov 05, 2026 08:32 AM	gcs	15.0
VIT-004807	Thu Nov 05, 2026 04:32 PM	spo2	98.0	room air
VIT-004808	Thu Nov 05, 2026 04:32 PM	rr	17.0
VIT-004849	Thu Nov 05, 2026 04:32 PM	temp_c	37.5
VIT-004850	Thu Nov 05, 2026 04:32 PM	hr	77.0
VIT-004851	Thu Nov 05, 2026 04:32 PM	map	83.0
VIT-004852	Thu Nov 05, 2026 04:32 PM	gcs	15.0
VIT-004809	Fri Nov 06, 2026 12:32 AM	spo2	96.0	room air
VIT-004810	Fri Nov 06, 2026 12:32 AM	rr	16.0
VIT-004853	Fri Nov 06, 2026 12:32 AM	temp_c	37.3
VIT-004854	Fri Nov 06, 2026 12:32 AM	hr	76.0
VIT-004855	Fri Nov 06, 2026 12:32 AM	map	83.0
VIT-004856	Fri Nov 06, 2026 12:32 AM	gcs	15.0
VIT-004811	Fri Nov 06, 2026 08:32 AM	spo2	97.0	room air
VIT-004812	Fri Nov 06, 2026 08:32 AM	rr	20.0
VIT-004857	Fri Nov 06, 2026 08:32 AM	temp_c	36.7
VIT-004858	Fri Nov 06, 2026 08:32 AM	hr	86.0
VIT-004859	Fri Nov 06, 2026 08:32 AM	map	90.0
VIT-004860	Fri Nov 06, 2026 08:32 AM	gcs	15.0
VIT-004813	Fri Nov 06, 2026 04:32 PM	spo2	97.0	room air
VIT-004814	Fri Nov 06, 2026 04:32 PM	rr	14.0
VIT-004861	Fri Nov 06, 2026 04:32 PM	temp_c	36.5
VIT-004862	Fri Nov 06, 2026 04:32 PM	hr	74.0
VIT-004863	Fri Nov 06, 2026 04:32 PM	map	87.0
VIT-004864	Fri Nov 06, 2026 04:32 PM	gcs	15.0
VIT-004815	Sat Nov 07, 2026 12:32 AM	spo2	96.0	room air
VIT-004816	Sat Nov 07, 2026 12:32 AM	rr	20.0
VIT-004865	Sat Nov 07, 2026 12:32 AM	temp_c	37.4
VIT-004866	Sat Nov 07, 2026 12:32 AM	hr	78.0
VIT-004867	Sat Nov 07, 2026 12:32 AM	map	79.0
VIT-004868	Sat Nov 07, 2026 12:32 AM	gcs	15.0
VIT-004817	Sat Nov 07, 2026 08:32 AM	spo2	97.0	room air
VIT-004818	Sat Nov 07, 2026 08:32 AM	rr	19.0
VIT-004869	Sat Nov 07, 2026 08:32 AM	temp_c	37.4
VIT-004870	Sat Nov 07, 2026 08:32 AM	hr	72.0
VIT-004871	Sat Nov 07, 2026 08:32 AM	map	80.0
VIT-004872	Sat Nov 07, 2026 08:32 AM	gcs	15.0
VIT-004819	Sat Nov 07, 2026 04:32 PM	spo2	94.0	room air
VIT-004820	Sat Nov 07, 2026 04:32 PM	rr	19.0
VIT-004873	Sat Nov 07, 2026 04:32 PM	temp_c	36.7
VIT-004874	Sat Nov 07, 2026 04:32 PM	hr	79.0
VIT-004875	Sat Nov 07, 2026 04:32 PM	map	74.0
VIT-004876	Sat Nov 07, 2026 04:32 PM	gcs	15.0
VIT-004821	Sun Nov 08, 2026 12:32 AM	spo2	98.0	room air
VIT-004822	Sun Nov 08, 2026 12:32 AM	rr	16.0
VIT-004877	Sun Nov 08, 2026 12:32 AM	temp_c	36.7
VIT-004878	Sun Nov 08, 2026 12:32 AM	hr	72.0
VIT-004879	Sun Nov 08, 2026 12:32 AM	map	83.0
VIT-004880	Sun Nov 08, 2026 12:32 AM	gcs	15.0
VIT-004823	Sun Nov 08, 2026 08:32 AM	spo2	97.0	room air
VIT-004824	Sun Nov 08, 2026 08:32 AM	rr	16.0
VIT-004881	Sun Nov 08, 2026 08:32 AM	temp_c	37.1
VIT-004882	Sun Nov 08, 2026 08:32 AM	hr	71.0
VIT-004883	Sun Nov 08, 2026 08:32 AM	map	75.0
VIT-004884	Sun Nov 08, 2026 08:32 AM	gcs	15.0

Medications, orders, echo, history (9)

MED-000173 11-03 17:12 piperacillin-tazobactam per protocol IV
MED-000174 11-04 05:00 piperacillin-tazobactam per protocol IV
MED-000175 11-05 05:00 cefepime per protocol IV
MED-000176 11-03 09:12 furosemide 40 mg PO
MED-000177 11-04 09:00 furosemide 40 mg PO
MED-000178 11-05 09:00 furosemide 40 mg PO
ORD-000041 11-03 16:42 blood_culture: blood cultures x2
ECH-000021 2026-11-04 echo LVEF 27.0%
HX-000015 history: heart failure with reduced ejection fraction

Notes

History and physical · DOC-000170 · Dr. Noor Halvorsen (resident) · Tue Nov 03, 2026 07:12 PM

Cited facts from this note (2)

bleeding_source: bleeding · cited p. 1, line 7 · confidence 0.50

Show source for bleeding_source

… -ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: heart failure with reduced ejection fraction. Denies bleeding, chest pain or fever. Exam: Lungs: clear to auscultation bilaterally. Assessment and plan: 1. Community-acquired pneumonia: antibiotics.
infection_source: right lower lobe pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… Hospital Medicine Attending: Dr. Wes Merriweather History of present illness: 79-year-old man admitted with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: heart failure with reduced ejection fraction. Denies bleeding, chest pain or fever. Exam: …

Source document DOC-000170: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Ximena Vance   MRN: MRN27659120   Admitted: 2026-11-03 16:12
Service: Hospital Medicine   Attending: Dr. Wes Merriweather

History of present illness: 79-year-old man admitted with community-acquired pneumonia. Chest x-ray shows right lower lobe pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: heart failure with reduced ejection fraction.
Denies bleeding, chest pain or fever.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Community-acquired pneumonia: antibiotics.

Wound care note · DOC-000169 · Ines Ingram, RN, CWOCN (wound_nurse) · Wed Nov 04, 2026 06:12 PM

Cited facts from this note (2)

wound_site: sacral · cited p. 1, line 3 · confidence 0.85

Show source for wound_site

Wound/ostomy nurse follow-up Sacral pressure injury, Stage III. Full-thickness skin loss, adipose visible, no tendon or bone. Measures 4.1 x 2.4 x 0.8 cm. Turning schedule reinforced with staff; low-air-loss sur …
wound_stage: Not found · quoted span not found in source · value withheld

Source document DOC-000169: Wound care note (synthetic)

Wound/ostomy nurse follow-up

Sacral pressure injury, Stage III. Full-thickness skin loss, adipose visible, no tendon or bone. Measures 4.1 x 2.4 x 0.8 cm.
Turning schedule reinforced with staff; low-air-loss surface ordered.

Progress note · DOC-000171 · Dr. Noor Halvorsen (resident) · Thu Nov 05, 2026 07:12 PM

Source document DOC-000171: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Ximena Vance   MRN: MRN27659120   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. Acute kidney injury: trend creatinine, hold nephrotoxins, strict intake and output.
3. Chronic systolic heart failure: diuresis and daily weights; monitor electrolytes.
4. Acute blood loss anemia: trend hemoglobin, transfuse if needed.
5. Stage 3 sacral pressure injury: wound care following, offloading.

Resident: Dr. Noor Halvorsen   Attending cosign: completed

Discharge summary · DOC-000172 · Dr. Wes Merriweather (attending) · Sun Nov 08, 2026 03:05 PM

Source document DOC-000172: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Ximena Vance   MRN: MRN27659120
Admitted 2026-11-03; discharged 2026-11-08.

Discharge diagnoses:
- community-acquired pneumonia
- acute kidney injury
- chronic systolic heart failure
- acute blood loss anemia
- stage 3 sacral pressure injury

Disposition: home with follow-up.