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-00051: Vera Ravensworth

50F · MRN30322283 · Cardiology · admitted Tue Oct 27, 2026 02:02 PM · discharged Mon Nov 02, 2026 02:39 PM · attending Dr. Cyrus Ellingham · 170 cm, 60.0 kg

Documented diagnoses (current)

“moderate protein-calorie malnutrition” · E44.0 Moderate protein-calorie malnutrition
Principal: “diastolic heart failure” · I50.30 Unspecified diastolic (congestive) heart failure
“anemia” · D64.9 Anemia, unspecified
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis
“type 2 diabetes” · E11.9 Type 2 diabetes mellitus without complications

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

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=1.036, 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=1.036, t.ratio_s3=3.0, creat_peak=0.87, 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=1.036, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	false
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=False, meets_definition=False	0
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.03, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria met

No gap

Supported as documented (D64.9).

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
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=9.71, 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=0.2, 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=True, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=True, hgb_drop=0.2, 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=241, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=83.4, egfr_late=84.6	84.6
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=83.4, t.g2=60, egfr_late=84.6	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=84.6, 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=83.4, egfr_late=84.6, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=84.6, t.g2=60	true

Heart failure

Criteria met

Specificity gap

Documented “diastolic heart failure” (I50.30); criteria support the more specific Chronic diastolic (HFpEF) heart failure (I50.32).

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=82.0, 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=61.0, t.ref=40, t.pres=50	diastolic
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=61.0, 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=diastolic	false
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=chronic	false
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=diastolic, acuity=chronic	false
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=diastolic, acuity=chronic	false
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=diastolic, acuity=chronic	false
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=diastolic, acuity=chronic	false
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=diastolic, 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=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

No gap

Supported as documented (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=80.0, t.a_sev_intake_pct=50, intake_days=42.0, 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=80.0, t.a_mod_intake_pct=75, intake_days=42.0, 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=30.0, wt_loss_pct=5.0	false
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=5.0	true
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=80.0, t.c_intake_pct=75, intake_days=42.0, 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=80.0, t.c_intake_pct=75, intake_days=42.0, 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=5.0	false
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=5.0	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=80.0, wt_loss_pct=5.0, 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=chronic, a_sev_intake=False, a_sev_wt=False, fat_loss=1, muscle_loss=1, fluid=0, grip_reduced=unknown, c_sev_intake=False, c_sev_wt=False	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=chronic, a_sev_intake=False, a_mod_intake=False, a_sev_wt=False, 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=False, c_mod_wt=True	3
outcome: severe	`n_severe >= 2`	n_severe=0	false
outcome: moderate	`n_moderate >= 2`	n_moderate=3	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=50, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=20.8, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=20.8, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=20.8, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=20.8, 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=37.6, t.t_hi=38, temp_min_48h=36.7, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=85.0, 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=8.68, t.wbc_hi=12, wbc_min_48h=7.24, 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=182.0	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=0.52	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=83.0	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=0.87	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=0.84	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 (39)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001739	Thu Jan 08, 2026 09:15 AM	creatinine	0.85 mg/dL
LAB-001740	Mon Sep 07, 2026 10:05 AM	creatinine	0.84 mg/dL
LAB-001741	Tue Oct 27, 2026 03:02 PM	creatinine	0.86 mg/dL
LAB-001748	Tue Oct 27, 2026 03:02 PM	bnp	82.0 pg/mL
LAB-001749	Tue Oct 27, 2026 03:02 PM	sodium	139.0 mmol/L
LAB-001756	Tue Oct 27, 2026 03:02 PM	hemoglobin	9.72 g/dL
LAB-001763	Tue Oct 27, 2026 03:02 PM	wbc	7.47 x10^3/uL
LAB-001764	Tue Oct 27, 2026 03:02 PM	platelets	188.0 x10^3/uL
LAB-001777	Tue Oct 27, 2026 03:02 PM	bilirubin	0.52 mg/dL
LAB-001742	Wed Oct 28, 2026 05:00 AM	creatinine	0.84 mg/dL
LAB-001750	Wed Oct 28, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001757	Wed Oct 28, 2026 05:00 AM	hemoglobin	9.76 g/dL
LAB-001765	Wed Oct 28, 2026 05:00 AM	wbc	8.68 x10^3/uL
LAB-001766	Wed Oct 28, 2026 05:00 AM	platelets	182.0 x10^3/uL
LAB-001743	Thu Oct 29, 2026 05:00 AM	creatinine	0.87 mg/dL
LAB-001751	Thu Oct 29, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001758	Thu Oct 29, 2026 05:00 AM	hemoglobin	9.88 g/dL
LAB-001767	Thu Oct 29, 2026 05:00 AM	wbc	7.24 x10^3/uL
LAB-001768	Thu Oct 29, 2026 05:00 AM	platelets	213.0 x10^3/uL
LAB-001744	Fri Oct 30, 2026 05:00 AM	creatinine	0.85 mg/dL
LAB-001752	Fri Oct 30, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001759	Fri Oct 30, 2026 05:00 AM	hemoglobin	9.84 g/dL
LAB-001769	Fri Oct 30, 2026 05:00 AM	wbc	10.79 x10^3/uL
LAB-001770	Fri Oct 30, 2026 05:00 AM	platelets	222.0 x10^3/uL
LAB-001745	Sat Oct 31, 2026 05:00 AM	creatinine	0.84 mg/dL
LAB-001753	Sat Oct 31, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-001760	Sat Oct 31, 2026 05:00 AM	hemoglobin	9.81 g/dL
LAB-001771	Sat Oct 31, 2026 05:00 AM	wbc	6.4 x10^3/uL
LAB-001772	Sat Oct 31, 2026 05:00 AM	platelets	308.0 x10^3/uL
LAB-001746	Sun Nov 01, 2026 05:00 AM	creatinine	0.86 mg/dL
LAB-001754	Sun Nov 01, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-001761	Sun Nov 01, 2026 05:00 AM	hemoglobin	9.71 g/dL
LAB-001773	Sun Nov 01, 2026 05:00 AM	wbc	10.09 x10^3/uL
LAB-001774	Sun Nov 01, 2026 05:00 AM	platelets	238.0 x10^3/uL
LAB-001747	Mon Nov 02, 2026 05:00 AM	creatinine	0.86 mg/dL
LAB-001755	Mon Nov 02, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-001762	Mon Nov 02, 2026 05:00 AM	hemoglobin	9.82 g/dL
LAB-001775	Mon Nov 02, 2026 05:00 AM	wbc	10.32 x10^3/uL
LAB-001776	Mon Nov 02, 2026 05:00 AM	platelets	226.0 x10^3/uL

Vitals (114)

Vitals
Row	When	Kind	Value	Detail
VIT-005011	Tue Oct 27, 2026 02:22 PM	spo2	95.0	room air
VIT-005012	Tue Oct 27, 2026 02:22 PM	rr	17.0
VIT-005049	Tue Oct 27, 2026 02:22 PM	temp_c	37.0
VIT-005050	Tue Oct 27, 2026 02:22 PM	hr	70.0
VIT-005051	Tue Oct 27, 2026 02:22 PM	map	90.0
VIT-005052	Tue Oct 27, 2026 02:22 PM	gcs	15.0
VIT-005013	Tue Oct 27, 2026 10:22 PM	spo2	94.0	room air
VIT-005014	Tue Oct 27, 2026 10:22 PM	rr	19.0
VIT-005053	Tue Oct 27, 2026 10:22 PM	temp_c	36.8
VIT-005054	Tue Oct 27, 2026 10:22 PM	hr	68.0
VIT-005055	Tue Oct 27, 2026 10:22 PM	map	84.0
VIT-005056	Tue Oct 27, 2026 10:22 PM	gcs	15.0
VIT-005015	Wed Oct 28, 2026 06:22 AM	spo2	98.0	room air
VIT-005016	Wed Oct 28, 2026 06:22 AM	rr	14.0
VIT-005057	Wed Oct 28, 2026 06:22 AM	temp_c	37.6
VIT-005058	Wed Oct 28, 2026 06:22 AM	hr	84.0
VIT-005059	Wed Oct 28, 2026 06:22 AM	map	86.0
VIT-005060	Wed Oct 28, 2026 06:22 AM	gcs	15.0
VIT-005017	Wed Oct 28, 2026 02:22 PM	spo2	99.0	room air
VIT-005018	Wed Oct 28, 2026 02:22 PM	rr	16.0
VIT-005061	Wed Oct 28, 2026 02:22 PM	temp_c	36.7
VIT-005062	Wed Oct 28, 2026 02:22 PM	hr	85.0
VIT-005063	Wed Oct 28, 2026 02:22 PM	map	83.0
VIT-005064	Wed Oct 28, 2026 02:22 PM	gcs	15.0
VIT-005019	Wed Oct 28, 2026 10:22 PM	spo2	99.0	room air
VIT-005020	Wed Oct 28, 2026 10:22 PM	rr	20.0
VIT-005065	Wed Oct 28, 2026 10:22 PM	temp_c	37.1
VIT-005066	Wed Oct 28, 2026 10:22 PM	hr	82.0
VIT-005067	Wed Oct 28, 2026 10:22 PM	map	86.0
VIT-005068	Wed Oct 28, 2026 10:22 PM	gcs	15.0
VIT-005021	Thu Oct 29, 2026 06:22 AM	spo2	97.0	room air
VIT-005022	Thu Oct 29, 2026 06:22 AM	rr	14.0
VIT-005069	Thu Oct 29, 2026 06:22 AM	temp_c	36.7
VIT-005070	Thu Oct 29, 2026 06:22 AM	hr	83.0
VIT-005071	Thu Oct 29, 2026 06:22 AM	map	83.0
VIT-005072	Thu Oct 29, 2026 06:22 AM	gcs	15.0
VIT-005023	Thu Oct 29, 2026 02:22 PM	spo2	94.0	room air
VIT-005024	Thu Oct 29, 2026 02:22 PM	rr	18.0
VIT-005073	Thu Oct 29, 2026 02:22 PM	temp_c	37.1
VIT-005074	Thu Oct 29, 2026 02:22 PM	hr	90.0
VIT-005075	Thu Oct 29, 2026 02:22 PM	map	74.0
VIT-005076	Thu Oct 29, 2026 02:22 PM	gcs	15.0
VIT-005025	Thu Oct 29, 2026 10:22 PM	spo2	94.0	room air
VIT-005026	Thu Oct 29, 2026 10:22 PM	rr	20.0
VIT-005077	Thu Oct 29, 2026 10:22 PM	temp_c	36.7
VIT-005078	Thu Oct 29, 2026 10:22 PM	hr	87.0
VIT-005079	Thu Oct 29, 2026 10:22 PM	map	78.0
VIT-005080	Thu Oct 29, 2026 10:22 PM	gcs	15.0
VIT-005027	Fri Oct 30, 2026 06:22 AM	spo2	97.0	room air
VIT-005028	Fri Oct 30, 2026 06:22 AM	rr	19.0
VIT-005081	Fri Oct 30, 2026 06:22 AM	temp_c	37.0
VIT-005082	Fri Oct 30, 2026 06:22 AM	hr	68.0
VIT-005083	Fri Oct 30, 2026 06:22 AM	map	79.0
VIT-005084	Fri Oct 30, 2026 06:22 AM	gcs	15.0
VIT-005029	Fri Oct 30, 2026 02:22 PM	spo2	94.0	room air
VIT-005030	Fri Oct 30, 2026 02:22 PM	rr	17.0
VIT-005085	Fri Oct 30, 2026 02:22 PM	temp_c	37.4
VIT-005086	Fri Oct 30, 2026 02:22 PM	hr	69.0
VIT-005087	Fri Oct 30, 2026 02:22 PM	map	89.0
VIT-005088	Fri Oct 30, 2026 02:22 PM	gcs	15.0
VIT-005031	Fri Oct 30, 2026 10:22 PM	spo2	94.0	room air
VIT-005032	Fri Oct 30, 2026 10:22 PM	rr	15.0
VIT-005089	Fri Oct 30, 2026 10:22 PM	temp_c	37.0
VIT-005090	Fri Oct 30, 2026 10:22 PM	hr	71.0
VIT-005091	Fri Oct 30, 2026 10:22 PM	map	92.0
VIT-005092	Fri Oct 30, 2026 10:22 PM	gcs	15.0
VIT-005033	Sat Oct 31, 2026 06:22 AM	spo2	97.0	room air
VIT-005034	Sat Oct 31, 2026 06:22 AM	rr	20.0
VIT-005093	Sat Oct 31, 2026 06:22 AM	temp_c	37.0
VIT-005094	Sat Oct 31, 2026 06:22 AM	hr	73.0
VIT-005095	Sat Oct 31, 2026 06:22 AM	map	83.0
VIT-005096	Sat Oct 31, 2026 06:22 AM	gcs	15.0
VIT-005035	Sat Oct 31, 2026 02:22 PM	spo2	98.0	room air
VIT-005036	Sat Oct 31, 2026 02:22 PM	rr	17.0
VIT-005097	Sat Oct 31, 2026 02:22 PM	temp_c	36.7
VIT-005098	Sat Oct 31, 2026 02:22 PM	hr	82.0
VIT-005099	Sat Oct 31, 2026 02:22 PM	map	91.0
VIT-005100	Sat Oct 31, 2026 02:22 PM	gcs	15.0
VIT-005037	Sat Oct 31, 2026 10:22 PM	spo2	99.0	room air
VIT-005038	Sat Oct 31, 2026 10:22 PM	rr	16.0
VIT-005101	Sat Oct 31, 2026 10:22 PM	temp_c	36.8
VIT-005102	Sat Oct 31, 2026 10:22 PM	hr	76.0
VIT-005103	Sat Oct 31, 2026 10:22 PM	map	92.0
VIT-005104	Sat Oct 31, 2026 10:22 PM	gcs	15.0
VIT-005039	Sun Nov 01, 2026 06:22 AM	spo2	96.0	room air
VIT-005040	Sun Nov 01, 2026 06:22 AM	rr	17.0
VIT-005105	Sun Nov 01, 2026 06:22 AM	temp_c	37.4
VIT-005106	Sun Nov 01, 2026 06:22 AM	hr	73.0
VIT-005107	Sun Nov 01, 2026 06:22 AM	map	76.0
VIT-005108	Sun Nov 01, 2026 06:22 AM	gcs	15.0
VIT-005041	Sun Nov 01, 2026 02:22 PM	spo2	97.0	room air
VIT-005042	Sun Nov 01, 2026 02:22 PM	rr	19.0
VIT-005109	Sun Nov 01, 2026 02:22 PM	temp_c	37.5
VIT-005110	Sun Nov 01, 2026 02:22 PM	hr	69.0
VIT-005111	Sun Nov 01, 2026 02:22 PM	map	79.0
VIT-005112	Sun Nov 01, 2026 02:22 PM	gcs	15.0
VIT-005043	Sun Nov 01, 2026 10:22 PM	spo2	98.0	room air
VIT-005044	Sun Nov 01, 2026 10:22 PM	rr	16.0
VIT-005113	Sun Nov 01, 2026 10:22 PM	temp_c	36.6
VIT-005114	Sun Nov 01, 2026 10:22 PM	hr	90.0
VIT-005115	Sun Nov 01, 2026 10:22 PM	map	79.0
VIT-005116	Sun Nov 01, 2026 10:22 PM	gcs	15.0
VIT-005045	Mon Nov 02, 2026 06:22 AM	spo2	97.0	room air
VIT-005046	Mon Nov 02, 2026 06:22 AM	rr	16.0
VIT-005117	Mon Nov 02, 2026 06:22 AM	temp_c	36.7
VIT-005118	Mon Nov 02, 2026 06:22 AM	hr	85.0
VIT-005119	Mon Nov 02, 2026 06:22 AM	map	84.0
VIT-005120	Mon Nov 02, 2026 06:22 AM	gcs	15.0
VIT-005047	Mon Nov 02, 2026 02:22 PM	spo2	98.0	room air
VIT-005048	Mon Nov 02, 2026 02:22 PM	rr	14.0
VIT-005121	Mon Nov 02, 2026 02:22 PM	temp_c	37.4
VIT-005122	Mon Nov 02, 2026 02:22 PM	hr	71.0
VIT-005123	Mon Nov 02, 2026 02:22 PM	map	92.0
VIT-005124	Mon Nov 02, 2026 02:22 PM	gcs	15.0

Medications, orders, echo, history (5)

MED-000185 10-27 09:02 furosemide 40 mg PO
MED-000186 10-28 09:00 furosemide 40 mg PO
MED-000187 10-29 09:00 furosemide 40 mg PO
ECH-000023 2026-10-28 echo LVEF 61.0%
HX-000016 history: heart failure with preserved ejection fraction

Notes

History and physical · DOC-000178 · Dr. Cyrus Ellingham (attending) · Tue Oct 27, 2026 05:02 PM

Source document DOC-000178: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Vera Ravensworth   MRN: MRN30322283   Admitted: 2026-10-27 14:02
Service: Cardiology   Attending: Dr. Cyrus Ellingham

History of present illness: 50-year-old woman admitted with diastolic heart failure. 
Past medical history: heart failure with preserved ejection fraction, GERD, type 2 diabetes.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Diastolic heart failure: diuresis and daily weights; monitor electrolytes.

Nutrition assessment · DOC-000177 · Dario Larkspur, RD (dietitian) · Wed Oct 28, 2026 08:02 PM

Cited facts from this note (8)

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

Show source for fat_loss

… text: chronic illness Intake: estimated energy intake 80% of needs for 42 days. Weight history: 5.0% 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

Show source for fluid_accumulation

… e 80% of needs for 42 days. Weight history: 5.0% 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: 42 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Vera Ravensworth MRN: MRN30322283 Context: chronic illness Intake: estimated energy intake 80% of needs for 42 days. Weight history: 5.0% weight loss over 30 days. Nutrition-focused physical exam: mild loss of subcutaneous fat; mild muscle wasting; no fluid accumulation. Rec …
intake_pct: 80 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Vera Ravensworth MRN: MRN30322283 Context: chronic illness Intake: estimated energy intake 80% of needs for 42 days. Weight history: 5.0% 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

Show source for muscle_loss

… stimated energy intake 80% of needs for 42 days. Weight history: 5.0% 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: chronic · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Vera Ravensworth MRN: MRN30322283 Context: chronic illness Intake: estimated energy intake 80% of needs for 42 days. Weight history: 5.0% 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

Show source for weight_loss_days

… red Dietitian) Patient: Vera Ravensworth MRN: MRN30322283 Context: chronic illness Intake: estimated energy intake 80% of needs for 42 days. Weight history: 5.0% 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 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… red Dietitian) Patient: Vera Ravensworth MRN: MRN30322283 Context: chronic illness Intake: estimated energy intake 80% of needs for 42 days. Weight history: 5.0% 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-000177: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Vera Ravensworth   MRN: MRN30322283

Context: chronic illness
Intake: estimated energy intake 80% of needs for 42 days.
Weight history: 5.0% 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-000179 · Dr. Cyrus Ellingham (attending) · Thu Oct 29, 2026 06:02 PM

Source document DOC-000179: Progress note (synthetic)

PROGRESS NOTE (Attending)
Patient: Vera Ravensworth   MRN: MRN30322283   Hospital day 3

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Diastolic heart failure: continue current management.
2. Moderate protein-calorie malnutrition: dietitian following, supplements.
3. Anemia: trend hemoglobin.

Attending: Dr. Cyrus Ellingham

Discharge summary · DOC-000180 · Dr. Cyrus Ellingham (attending) · Mon Nov 02, 2026 02:39 PM

Source document DOC-000180: Discharge summary (synthetic)

DISCHARGE SUMMARY
Patient: Vera Ravensworth   MRN: MRN30322283
Admitted 2026-10-27; discharged 2026-11-02.

Discharge diagnoses:
- moderate protein-calorie malnutrition
- diastolic heart failure
- anemia
- GERD
- type 2 diabetes

Disposition: home with follow-up.