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-00050: Jun Upfield

75F · MRN68120228 · Cardiology · admitted Sun Oct 25, 2026 02:06 PM · discharged Sun Nov 01, 2026 01:45 PM · attending Dr. Cyrus Ellingham · 165 cm, 79.3 kg

Documented diagnoses (current)

“CKD stage 3a” · N18.31 Chronic kidney disease, stage 3a
“AKI” · N17.9 Acute kidney failure, unspecified
Principal: “acute systolic heart failure” · I50.21 Acute systolic (congestive) heart failure
“anemia” · D64.9 Anemia, unspecified
“hypertension” · I10 Essential (primary) hypertension

Illustrative grouping now: MS-DRG 292 Heart failure and shock with CC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 292.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

Clinical validation gap

Documented “AKI” (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=1.035, t.ratio_s1=1.5, creat_rise_48h=0.04, 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=1.035, t.ratio_s3=3.0, creat_peak=0.89, 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=1.035, 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=0.04, 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=F, hgb_nadir=9.38, 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=2.9, 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

Clinical judgement required: Pre-admission eGFR values fall on both sides of 60.

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=298, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=55.4, egfr_late=70.4	70.4
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=55.4, t.g2=60, egfr_late=70.4	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=70.4, 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=55.4, egfr_late=70.4, t.g2=60	true

Heart failure

Criteria met

No gap

Supported as documented (I50.21).

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=2018.0, 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=34.0, 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=34.0, 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=False	acute
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=acute	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=systolic, acuity=acute	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=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=75, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=29.1, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=29.1, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=29.1, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=29.1, 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=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=36.6, 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=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=10.43, t.wbc_hi=12, wbc_min_48h=5.88, 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=254.0	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=0.42	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=0.89	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=0.86	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)
Row	When	Test	Value
LAB-001695	Sat Sep 13, 2025 09:15 AM	creatinine	1.05 mg/dL
LAB-001696	Wed Jul 08, 2026 10:05 AM	creatinine	0.86 mg/dL
LAB-001697	Sun Oct 25, 2026 03:06 PM	creatinine	0.86 mg/dL
LAB-001705	Sun Oct 25, 2026 03:06 PM	bnp	2018.0 pg/mL
LAB-001706	Sun Oct 25, 2026 03:06 PM	sodium	141.0 mmol/L
LAB-001714	Sun Oct 25, 2026 03:06 PM	hemoglobin	12.27 g/dL
LAB-001722	Sun Oct 25, 2026 03:06 PM	wbc	10.43 x10^3/uL
LAB-001723	Sun Oct 25, 2026 03:06 PM	platelets	259.0 x10^3/uL
LAB-001738	Sun Oct 25, 2026 03:06 PM	bilirubin	0.42 mg/dL
LAB-001698	Mon Oct 26, 2026 05:00 AM	creatinine	0.89 mg/dL
LAB-001707	Mon Oct 26, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001715	Mon Oct 26, 2026 05:00 AM	hemoglobin	10.54 g/dL
LAB-001724	Mon Oct 26, 2026 05:00 AM	wbc	8.68 x10^3/uL
LAB-001725	Mon Oct 26, 2026 05:00 AM	platelets	254.0 x10^3/uL
LAB-001699	Tue Oct 27, 2026 05:00 AM	creatinine	0.85 mg/dL
LAB-001708	Tue Oct 27, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001716	Tue Oct 27, 2026 05:00 AM	hemoglobin	9.38 g/dL
LAB-001726	Tue Oct 27, 2026 05:00 AM	wbc	5.88 x10^3/uL
LAB-001727	Tue Oct 27, 2026 05:00 AM	platelets	286.0 x10^3/uL
LAB-001700	Wed Oct 28, 2026 05:00 AM	creatinine	0.88 mg/dL
LAB-001709	Wed Oct 28, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-001717	Wed Oct 28, 2026 05:00 AM	hemoglobin	10.18 g/dL
LAB-001728	Wed Oct 28, 2026 05:00 AM	wbc	6.62 x10^3/uL
LAB-001729	Wed Oct 28, 2026 05:00 AM	platelets	276.0 x10^3/uL
LAB-001701	Thu Oct 29, 2026 05:00 AM	creatinine	0.85 mg/dL
LAB-001710	Thu Oct 29, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001718	Thu Oct 29, 2026 05:00 AM	hemoglobin	10.48 g/dL
LAB-001730	Thu Oct 29, 2026 05:00 AM	wbc	7.34 x10^3/uL
LAB-001731	Thu Oct 29, 2026 05:00 AM	platelets	220.0 x10^3/uL
LAB-001702	Fri Oct 30, 2026 05:00 AM	creatinine	0.89 mg/dL
LAB-001711	Fri Oct 30, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-001719	Fri Oct 30, 2026 05:00 AM	hemoglobin	10.58 g/dL
LAB-001732	Fri Oct 30, 2026 05:00 AM	wbc	6.49 x10^3/uL
LAB-001733	Fri Oct 30, 2026 05:00 AM	platelets	281.0 x10^3/uL
LAB-001703	Sat Oct 31, 2026 05:00 AM	creatinine	0.88 mg/dL
LAB-001712	Sat Oct 31, 2026 05:00 AM	sodium	142.0 mmol/L
LAB-001720	Sat Oct 31, 2026 05:00 AM	hemoglobin	10.58 g/dL
LAB-001734	Sat Oct 31, 2026 05:00 AM	wbc	10.88 x10^3/uL
LAB-001735	Sat Oct 31, 2026 05:00 AM	platelets	229.0 x10^3/uL
LAB-001704	Sun Nov 01, 2026 05:00 AM	creatinine	0.88 mg/dL
LAB-001713	Sun Nov 01, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001721	Sun Nov 01, 2026 05:00 AM	hemoglobin	10.58 g/dL
LAB-001736	Sun Nov 01, 2026 05:00 AM	wbc	9.03 x10^3/uL
LAB-001737	Sun Nov 01, 2026 05:00 AM	platelets	200.0 x10^3/uL

Vitals (126)

Vitals
Row	When	Kind	Value	Detail
VIT-004885	Sun Oct 25, 2026 02:26 PM	spo2	95.0	room air
VIT-004886	Sun Oct 25, 2026 02:26 PM	rr	19.0
VIT-004927	Sun Oct 25, 2026 02:26 PM	temp_c	36.6
VIT-004928	Sun Oct 25, 2026 02:26 PM	hr	70.0
VIT-004929	Sun Oct 25, 2026 02:26 PM	map	79.0
VIT-004930	Sun Oct 25, 2026 02:26 PM	gcs	15.0
VIT-004887	Sun Oct 25, 2026 10:26 PM	spo2	94.0	room air
VIT-004888	Sun Oct 25, 2026 10:26 PM	rr	15.0
VIT-004931	Sun Oct 25, 2026 10:26 PM	temp_c	37.1
VIT-004932	Sun Oct 25, 2026 10:26 PM	hr	71.0
VIT-004933	Sun Oct 25, 2026 10:26 PM	map	79.0
VIT-004934	Sun Oct 25, 2026 10:26 PM	gcs	15.0
VIT-004889	Mon Oct 26, 2026 06:26 AM	spo2	97.0	room air
VIT-004890	Mon Oct 26, 2026 06:26 AM	rr	16.0
VIT-004935	Mon Oct 26, 2026 06:26 AM	temp_c	36.8
VIT-004936	Mon Oct 26, 2026 06:26 AM	hr	89.0
VIT-004937	Mon Oct 26, 2026 06:26 AM	map	88.0
VIT-004938	Mon Oct 26, 2026 06:26 AM	gcs	15.0
VIT-004891	Mon Oct 26, 2026 02:26 PM	spo2	97.0	room air
VIT-004892	Mon Oct 26, 2026 02:26 PM	rr	14.0
VIT-004939	Mon Oct 26, 2026 02:26 PM	temp_c	36.8
VIT-004940	Mon Oct 26, 2026 02:26 PM	hr	69.0
VIT-004941	Mon Oct 26, 2026 02:26 PM	map	74.0
VIT-004942	Mon Oct 26, 2026 02:26 PM	gcs	15.0
VIT-004893	Mon Oct 26, 2026 10:26 PM	spo2	95.0	room air
VIT-004894	Mon Oct 26, 2026 10:26 PM	rr	17.0
VIT-004943	Mon Oct 26, 2026 10:26 PM	temp_c	37.5
VIT-004944	Mon Oct 26, 2026 10:26 PM	hr	72.0
VIT-004945	Mon Oct 26, 2026 10:26 PM	map	84.0
VIT-004946	Mon Oct 26, 2026 10:26 PM	gcs	15.0
VIT-004895	Tue Oct 27, 2026 06:26 AM	spo2	98.0	room air
VIT-004896	Tue Oct 27, 2026 06:26 AM	rr	20.0
VIT-004947	Tue Oct 27, 2026 06:26 AM	temp_c	36.8
VIT-004948	Tue Oct 27, 2026 06:26 AM	hr	75.0
VIT-004949	Tue Oct 27, 2026 06:26 AM	map	75.0
VIT-004950	Tue Oct 27, 2026 06:26 AM	gcs	15.0
VIT-004897	Tue Oct 27, 2026 02:26 PM	spo2	97.0	room air
VIT-004898	Tue Oct 27, 2026 02:26 PM	rr	16.0
VIT-004951	Tue Oct 27, 2026 02:26 PM	temp_c	37.4
VIT-004952	Tue Oct 27, 2026 02:26 PM	hr	89.0
VIT-004953	Tue Oct 27, 2026 02:26 PM	map	88.0
VIT-004954	Tue Oct 27, 2026 02:26 PM	gcs	15.0
VIT-004899	Tue Oct 27, 2026 10:26 PM	spo2	96.0	room air
VIT-004900	Tue Oct 27, 2026 10:26 PM	rr	19.0
VIT-004955	Tue Oct 27, 2026 10:26 PM	temp_c	36.8
VIT-004956	Tue Oct 27, 2026 10:26 PM	hr	81.0
VIT-004957	Tue Oct 27, 2026 10:26 PM	map	78.0
VIT-004958	Tue Oct 27, 2026 10:26 PM	gcs	15.0
VIT-004901	Wed Oct 28, 2026 06:26 AM	spo2	95.0	room air
VIT-004902	Wed Oct 28, 2026 06:26 AM	rr	14.0
VIT-004959	Wed Oct 28, 2026 06:26 AM	temp_c	36.9
VIT-004960	Wed Oct 28, 2026 06:26 AM	hr	89.0
VIT-004961	Wed Oct 28, 2026 06:26 AM	map	77.0
VIT-004962	Wed Oct 28, 2026 06:26 AM	gcs	15.0
VIT-004903	Wed Oct 28, 2026 02:26 PM	spo2	99.0	room air
VIT-004904	Wed Oct 28, 2026 02:26 PM	rr	20.0
VIT-004963	Wed Oct 28, 2026 02:26 PM	temp_c	36.7
VIT-004964	Wed Oct 28, 2026 02:26 PM	hr	85.0
VIT-004965	Wed Oct 28, 2026 02:26 PM	map	89.0
VIT-004966	Wed Oct 28, 2026 02:26 PM	gcs	15.0
VIT-004905	Wed Oct 28, 2026 10:26 PM	spo2	99.0	room air
VIT-004906	Wed Oct 28, 2026 10:26 PM	rr	20.0
VIT-004967	Wed Oct 28, 2026 10:26 PM	temp_c	37.4
VIT-004968	Wed Oct 28, 2026 10:26 PM	hr	83.0
VIT-004969	Wed Oct 28, 2026 10:26 PM	map	80.0
VIT-004970	Wed Oct 28, 2026 10:26 PM	gcs	15.0
VIT-004907	Thu Oct 29, 2026 06:26 AM	spo2	95.0	room air
VIT-004908	Thu Oct 29, 2026 06:26 AM	rr	19.0
VIT-004971	Thu Oct 29, 2026 06:26 AM	temp_c	36.6
VIT-004972	Thu Oct 29, 2026 06:26 AM	hr	79.0
VIT-004973	Thu Oct 29, 2026 06:26 AM	map	92.0
VIT-004974	Thu Oct 29, 2026 06:26 AM	gcs	15.0
VIT-004909	Thu Oct 29, 2026 02:26 PM	spo2	96.0	room air
VIT-004910	Thu Oct 29, 2026 02:26 PM	rr	17.0
VIT-004975	Thu Oct 29, 2026 02:26 PM	temp_c	37.4
VIT-004976	Thu Oct 29, 2026 02:26 PM	hr	68.0
VIT-004977	Thu Oct 29, 2026 02:26 PM	map	74.0
VIT-004978	Thu Oct 29, 2026 02:26 PM	gcs	15.0
VIT-004911	Thu Oct 29, 2026 10:26 PM	spo2	95.0	room air
VIT-004912	Thu Oct 29, 2026 10:26 PM	rr	15.0
VIT-004979	Thu Oct 29, 2026 10:26 PM	temp_c	36.8
VIT-004980	Thu Oct 29, 2026 10:26 PM	hr	75.0
VIT-004981	Thu Oct 29, 2026 10:26 PM	map	82.0
VIT-004982	Thu Oct 29, 2026 10:26 PM	gcs	15.0
VIT-004913	Fri Oct 30, 2026 06:26 AM	spo2	95.0	room air
VIT-004914	Fri Oct 30, 2026 06:26 AM	rr	20.0
VIT-004983	Fri Oct 30, 2026 06:26 AM	temp_c	36.8
VIT-004984	Fri Oct 30, 2026 06:26 AM	hr	76.0
VIT-004985	Fri Oct 30, 2026 06:26 AM	map	85.0
VIT-004986	Fri Oct 30, 2026 06:26 AM	gcs	15.0
VIT-004915	Fri Oct 30, 2026 02:26 PM	spo2	98.0	room air
VIT-004916	Fri Oct 30, 2026 02:26 PM	rr	16.0
VIT-004987	Fri Oct 30, 2026 02:26 PM	temp_c	37.3
VIT-004988	Fri Oct 30, 2026 02:26 PM	hr	74.0
VIT-004989	Fri Oct 30, 2026 02:26 PM	map	80.0
VIT-004990	Fri Oct 30, 2026 02:26 PM	gcs	15.0
VIT-004917	Fri Oct 30, 2026 10:26 PM	spo2	96.0	room air
VIT-004918	Fri Oct 30, 2026 10:26 PM	rr	18.0
VIT-004991	Fri Oct 30, 2026 10:26 PM	temp_c	37.3
VIT-004992	Fri Oct 30, 2026 10:26 PM	hr	92.0
VIT-004993	Fri Oct 30, 2026 10:26 PM	map	87.0
VIT-004994	Fri Oct 30, 2026 10:26 PM	gcs	15.0
VIT-004919	Sat Oct 31, 2026 06:26 AM	spo2	95.0	room air
VIT-004920	Sat Oct 31, 2026 06:26 AM	rr	20.0
VIT-004995	Sat Oct 31, 2026 06:26 AM	temp_c	37.5
VIT-004996	Sat Oct 31, 2026 06:26 AM	hr	89.0
VIT-004997	Sat Oct 31, 2026 06:26 AM	map	80.0
VIT-004998	Sat Oct 31, 2026 06:26 AM	gcs	15.0
VIT-004921	Sat Oct 31, 2026 02:26 PM	spo2	95.0	room air
VIT-004922	Sat Oct 31, 2026 02:26 PM	rr	16.0
VIT-004999	Sat Oct 31, 2026 02:26 PM	temp_c	36.8
VIT-005000	Sat Oct 31, 2026 02:26 PM	hr	69.0
VIT-005001	Sat Oct 31, 2026 02:26 PM	map	91.0
VIT-005002	Sat Oct 31, 2026 02:26 PM	gcs	15.0
VIT-004923	Sat Oct 31, 2026 10:26 PM	spo2	98.0	room air
VIT-004924	Sat Oct 31, 2026 10:26 PM	rr	15.0
VIT-005003	Sat Oct 31, 2026 10:26 PM	temp_c	37.2
VIT-005004	Sat Oct 31, 2026 10:26 PM	hr	86.0
VIT-005005	Sat Oct 31, 2026 10:26 PM	map	81.0
VIT-005006	Sat Oct 31, 2026 10:26 PM	gcs	15.0
VIT-004925	Sun Nov 01, 2026 06:26 AM	spo2	95.0	room air
VIT-004926	Sun Nov 01, 2026 06:26 AM	rr	18.0
VIT-005007	Sun Nov 01, 2026 06:26 AM	temp_c	37.1
VIT-005008	Sun Nov 01, 2026 06:26 AM	hr	91.0
VIT-005009	Sun Nov 01, 2026 06:26 AM	map	76.0
VIT-005010	Sun Nov 01, 2026 06:26 AM	gcs	15.0

Medications, orders, echo, history (8)

MED-000179 10-25 08:00 furosemide 40 mg IV
MED-000180 10-25 20:00 furosemide 40 mg IV
MED-000181 10-26 08:00 furosemide 40 mg IV
MED-000182 10-26 20:00 furosemide 40 mg IV
MED-000183 10-27 08:00 furosemide 40 mg IV
MED-000184 10-27 20:00 furosemide 40 mg IV
ORD-000042 10-26 09:00 transfusion_prbc: transfuse PRBC
ECH-000022 2026-10-26 echo LVEF 34.0%

Notes

History and physical · DOC-000174 · Dr. Cyrus Ellingham (attending) · Sun Oct 25, 2026 05:06 PM

Cited facts from this note (1)

bleeding_source: bleeding from the surgical drain · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… logy Attending: Dr. Cyrus Ellingham History of present illness: 75-year-old woman admitted with acute systolic heart failure. Hospital course complicated by bleeding from the surgical drain. Past medical history: hypertension. Review of systems otherwise negative. Exam: Lungs: clear to auscultation bilaterally. Assessment and plan: 1. CKD stage 3a …

Source document DOC-000174: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Jun Upfield   MRN: MRN68120228   Admitted: 2026-10-25 14:06
Service: Cardiology   Attending: Dr. Cyrus Ellingham

History of present illness: 75-year-old woman admitted with acute systolic heart failure. Hospital course complicated by bleeding from the surgical drain.
Past medical history: hypertension.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. CKD stage 3a: renally dose medications.
2. Acute systolic heart failure: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000173 · Dario Larkspur, RD (dietitian) · Mon Oct 26, 2026 07:06 PM

Cited facts from this note (5)

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

Show source for fat_loss

… MRN: MRN68120228 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: Jun Upfield MRN: MRN68120228 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: Jun Upfield MRN: MRN68120228 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-000173: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Jun Upfield   MRN: MRN68120228

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-000175 · Dr. Cyrus Ellingham (attending) · Tue Oct 27, 2026 05:06 PM

Source document DOC-000175: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Jun Upfield   MRN: MRN68120228   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Acute systolic heart failure: continue current management.
2. AKI: trend creatinine, hold nephrotoxins, strict intake and output.
3. Anemia: trend hemoglobin.

Attending: Dr. Cyrus Ellingham

Discharge summary · DOC-000176 · Dr. Cyrus Ellingham (attending) · Sun Nov 01, 2026 01:45 PM

Source document DOC-000176: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Jun Upfield   MRN: MRN68120228
Admitted 2026-10-25; discharged 2026-11-01.

Discharge diagnoses:
- CKD stage 3a
- AKI
- acute systolic heart failure
- anemia
- hypertension

Disposition: home with follow-up.