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-00054: Elena Okafor

49M · MRN76087701 · Hospital Medicine · admitted Mon Nov 09, 2026 10:24 AM · in hospital · attending Dr. Wes Merriweather · resident Dr. Greta Kowalczyk · 178 cm, 68.4 kg

Documented diagnoses (current)

Principal: “sepsis” · A41.9 Sepsis, unspecified organism
“community-acquired pneumonia” · J18.9 Pneumonia, unspecified organism
“malnourished” · E46 Unspecified protein-calorie malnutrition
“CKD” · N18.9 Chronic kidney disease, unspecified

Illustrative grouping now: MS-DRG 871 Septicemia or severe sepsis without MV >96 hours 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

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=1.052, t.ratio_s1=1.5, creat_rise_48h=0.23, 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=1.052, t.ratio_s3=3.0, creat_peak=3.43, 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=1.052, 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=0.23, 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 not met

No gap

Not documented and not supported.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=M, hgb_nadir=14.17, t.hb_m=13, t.hb_f=12	false
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=0.3, t.drop_major=2.0, prbc_units=0, t.prbc_major=2	false
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=False, anaemic=False, acute_fall=False	false
outcome: anaemia_only	`anaemic and hgb_drop < t.drop_min and prbc_units == 0`	anaemic=False, hgb_drop=0.3, t.drop_min=1.0, prbc_units=0	false
outcome: not_anaemic	`present(hgb_nadir) and not anaemic`	hgb_nadir=14.17, anaemic=False	true

Chronic kidney disease

Criteria met

Specificity gap

Documented “CKD” (N18.9); criteria support the more specific Chronic kidney disease stage 4 (N18.4).

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=175, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=19.0, egfr_late=22.3	22.3
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=19.0, t.g2=60, egfr_late=22.3	true
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=22.3, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G4
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=True, egfr_early=19.0, egfr_late=22.3, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=22.3, t.g2=60	false
outcome: g3a	`category == 'G3a'`	category=G4	false
outcome: g3b	`category == 'G3b'`	category=G4	false
outcome: g4	`category == 'G4'`	category=G4	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 “malnourished” (E46); criteria support the more specific Severe protein-calorie malnutrition (acute illness context) (E43).

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=40.0, t.a_sev_intake_pct=50, intake_days=10.0, t.a_sev_intake_days=5	true
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=40.0, t.a_mod_intake_pct=75, intake_days=10.0, 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=5.6	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=5.6	true
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=40.0, t.c_intake_pct=75, intake_days=10.0, 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=40.0, t.c_intake_pct=75, intake_days=10.0, 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=5.6	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=5.6	true
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=40.0, wt_loss_pct=5.6, fat_loss=2, muscle_loss=2, fluid=0, grip_reduced=True	6
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=True, a_sev_wt=True, fat_loss=2, muscle_loss=2, fluid=0, grip_reduced=True, c_sev_intake=False, c_sev_wt=True	5
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=True, a_mod_intake=True, a_sev_wt=True, a_mod_wt=True, fat_loss=2, muscle_loss=2, fluid=0, grip_reduced=True, c_sev_intake=False, c_mod_intake=False, c_sev_wt=True, c_mod_wt=True	5
outcome: severe	`n_severe >= 2`	n_severe=5	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=49, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=21.6, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=21.6, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=21.6, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=21.6, 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

Clinical validation gap

Documented “sepsis” (A41.9) but the criteria are not met: Neither definition met: 0 SIRS criteria, SOFA change 0.

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=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=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=8.73, t.wbc_hi=12, wbc_min_48h=7.73, 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=214.0	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=0.51	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=3.43	2
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=3.26	2
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=2, sofa_renal_baseline=2	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 (28)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-001825	Thu Jan 29, 2026 09:15 AM	creatinine	3.73 mg/dL
LAB-001826	Fri Jul 24, 2026 10:05 AM	creatinine	3.26 mg/dL
LAB-001827	Mon Nov 09, 2026 11:24 AM	creatinine	3.39 mg/dL
LAB-001832	Mon Nov 09, 2026 11:24 AM	sodium	136.0 mmol/L
LAB-001837	Mon Nov 09, 2026 11:24 AM	hemoglobin	14.46 g/dL
LAB-001842	Mon Nov 09, 2026 11:24 AM	wbc	8.73 x10^3/uL
LAB-001843	Mon Nov 09, 2026 11:24 AM	platelets	217.0 x10^3/uL
LAB-001852	Mon Nov 09, 2026 11:24 AM	bilirubin	0.51 mg/dL
LAB-001828	Tue Nov 10, 2026 05:00 AM	creatinine	3.2 mg/dL
LAB-001833	Tue Nov 10, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-001838	Tue Nov 10, 2026 05:00 AM	hemoglobin	14.44 g/dL
LAB-001844	Tue Nov 10, 2026 05:00 AM	wbc	7.73 x10^3/uL
LAB-001845	Tue Nov 10, 2026 05:00 AM	platelets	214.0 x10^3/uL
LAB-001829	Wed Nov 11, 2026 05:00 AM	creatinine	3.43 mg/dL
LAB-001834	Wed Nov 11, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001839	Wed Nov 11, 2026 05:00 AM	hemoglobin	14.25 g/dL
LAB-001846	Wed Nov 11, 2026 05:00 AM	wbc	8.47 x10^3/uL
LAB-001847	Wed Nov 11, 2026 05:00 AM	platelets	273.0 x10^3/uL
LAB-001830	Thu Nov 12, 2026 05:00 AM	creatinine	3.26 mg/dL
LAB-001835	Thu Nov 12, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-001840	Thu Nov 12, 2026 05:00 AM	hemoglobin	14.17 g/dL
LAB-001848	Thu Nov 12, 2026 05:00 AM	wbc	7.88 x10^3/uL
LAB-001849	Thu Nov 12, 2026 05:00 AM	platelets	246.0 x10^3/uL
LAB-001831	Fri Nov 13, 2026 05:00 AM	creatinine	3.34 mg/dL
LAB-001836	Fri Nov 13, 2026 05:00 AM	sodium	137.0 mmol/L
LAB-001841	Fri Nov 13, 2026 05:00 AM	hemoglobin	14.5 g/dL
LAB-001850	Fri Nov 13, 2026 05:00 AM	wbc	7.19 x10^3/uL
LAB-001851	Fri Nov 13, 2026 05:00 AM	platelets	215.0 x10^3/uL

Vitals (78)

Vitals
Row	When	Kind	Value	Detail
VIT-005233	Mon Nov 09, 2026 10:44 AM	spo2	95.0	room air
VIT-005234	Mon Nov 09, 2026 10:44 AM	rr	18.0
VIT-005259	Mon Nov 09, 2026 10:44 AM	temp_c	37.6
VIT-005260	Mon Nov 09, 2026 10:44 AM	hr	80.0
VIT-005261	Mon Nov 09, 2026 10:44 AM	map	85.0
VIT-005262	Mon Nov 09, 2026 10:44 AM	gcs	15.0
VIT-005235	Mon Nov 09, 2026 06:44 PM	spo2	94.0	room air
VIT-005236	Mon Nov 09, 2026 06:44 PM	rr	16.0
VIT-005263	Mon Nov 09, 2026 06:44 PM	temp_c	36.7
VIT-005264	Mon Nov 09, 2026 06:44 PM	hr	83.0
VIT-005265	Mon Nov 09, 2026 06:44 PM	map	82.0
VIT-005266	Mon Nov 09, 2026 06:44 PM	gcs	15.0
VIT-005237	Tue Nov 10, 2026 02:44 AM	spo2	97.0	room air
VIT-005238	Tue Nov 10, 2026 02:44 AM	rr	18.0
VIT-005267	Tue Nov 10, 2026 02:44 AM	temp_c	37.2
VIT-005268	Tue Nov 10, 2026 02:44 AM	hr	86.0
VIT-005269	Tue Nov 10, 2026 02:44 AM	map	90.0
VIT-005270	Tue Nov 10, 2026 02:44 AM	gcs	15.0
VIT-005239	Tue Nov 10, 2026 10:44 AM	spo2	96.0	room air
VIT-005240	Tue Nov 10, 2026 10:44 AM	rr	18.0
VIT-005271	Tue Nov 10, 2026 10:44 AM	temp_c	36.9
VIT-005272	Tue Nov 10, 2026 10:44 AM	hr	83.0
VIT-005273	Tue Nov 10, 2026 10:44 AM	map	85.0
VIT-005274	Tue Nov 10, 2026 10:44 AM	gcs	15.0
VIT-005241	Tue Nov 10, 2026 06:44 PM	spo2	94.0	room air
VIT-005242	Tue Nov 10, 2026 06:44 PM	rr	19.0
VIT-005275	Tue Nov 10, 2026 06:44 PM	temp_c	37.1
VIT-005276	Tue Nov 10, 2026 06:44 PM	hr	75.0
VIT-005277	Tue Nov 10, 2026 06:44 PM	map	74.0
VIT-005278	Tue Nov 10, 2026 06:44 PM	gcs	15.0
VIT-005243	Wed Nov 11, 2026 02:44 AM	spo2	97.0	room air
VIT-005244	Wed Nov 11, 2026 02:44 AM	rr	15.0
VIT-005279	Wed Nov 11, 2026 02:44 AM	temp_c	37.2
VIT-005280	Wed Nov 11, 2026 02:44 AM	hr	73.0
VIT-005281	Wed Nov 11, 2026 02:44 AM	map	74.0
VIT-005282	Wed Nov 11, 2026 02:44 AM	gcs	15.0
VIT-005245	Wed Nov 11, 2026 10:44 AM	spo2	94.0	room air
VIT-005246	Wed Nov 11, 2026 10:44 AM	rr	20.0
VIT-005283	Wed Nov 11, 2026 10:44 AM	temp_c	36.6
VIT-005284	Wed Nov 11, 2026 10:44 AM	hr	83.0
VIT-005285	Wed Nov 11, 2026 10:44 AM	map	92.0
VIT-005286	Wed Nov 11, 2026 10:44 AM	gcs	15.0
VIT-005247	Wed Nov 11, 2026 06:44 PM	spo2	94.0	room air
VIT-005248	Wed Nov 11, 2026 06:44 PM	rr	19.0
VIT-005287	Wed Nov 11, 2026 06:44 PM	temp_c	37.0
VIT-005288	Wed Nov 11, 2026 06:44 PM	hr	76.0
VIT-005289	Wed Nov 11, 2026 06:44 PM	map	74.0
VIT-005290	Wed Nov 11, 2026 06:44 PM	gcs	15.0
VIT-005249	Thu Nov 12, 2026 02:44 AM	spo2	98.0	room air
VIT-005250	Thu Nov 12, 2026 02:44 AM	rr	18.0
VIT-005291	Thu Nov 12, 2026 02:44 AM	temp_c	37.5
VIT-005292	Thu Nov 12, 2026 02:44 AM	hr	73.0
VIT-005293	Thu Nov 12, 2026 02:44 AM	map	90.0
VIT-005294	Thu Nov 12, 2026 02:44 AM	gcs	15.0
VIT-005251	Thu Nov 12, 2026 10:44 AM	spo2	95.0	room air
VIT-005252	Thu Nov 12, 2026 10:44 AM	rr	14.0
VIT-005295	Thu Nov 12, 2026 10:44 AM	temp_c	36.7
VIT-005296	Thu Nov 12, 2026 10:44 AM	hr	87.0
VIT-005297	Thu Nov 12, 2026 10:44 AM	map	79.0
VIT-005298	Thu Nov 12, 2026 10:44 AM	gcs	15.0
VIT-005253	Thu Nov 12, 2026 06:44 PM	spo2	94.0	room air
VIT-005254	Thu Nov 12, 2026 06:44 PM	rr	20.0
VIT-005299	Thu Nov 12, 2026 06:44 PM	temp_c	37.6
VIT-005300	Thu Nov 12, 2026 06:44 PM	hr	80.0
VIT-005301	Thu Nov 12, 2026 06:44 PM	map	82.0
VIT-005302	Thu Nov 12, 2026 06:44 PM	gcs	15.0
VIT-005255	Fri Nov 13, 2026 02:44 AM	spo2	97.0	room air
VIT-005256	Fri Nov 13, 2026 02:44 AM	rr	19.0
VIT-005303	Fri Nov 13, 2026 02:44 AM	temp_c	37.6
VIT-005304	Fri Nov 13, 2026 02:44 AM	hr	84.0
VIT-005305	Fri Nov 13, 2026 02:44 AM	map	92.0
VIT-005306	Fri Nov 13, 2026 02:44 AM	gcs	15.0
VIT-005257	Fri Nov 13, 2026 10:44 AM	spo2	94.0	room air
VIT-005258	Fri Nov 13, 2026 10:44 AM	rr	17.0
VIT-005307	Fri Nov 13, 2026 10:44 AM	temp_c	37.4
VIT-005308	Fri Nov 13, 2026 10:44 AM	hr	81.0
VIT-005309	Fri Nov 13, 2026 10:44 AM	map	86.0
VIT-005310	Fri Nov 13, 2026 10:44 AM	gcs	15.0

Medications, orders, echo, history (4)

MED-000194 11-09 11:24 ceftriaxone per protocol IV
MED-000195 11-10 05:00 ceftriaxone per protocol IV
MED-000196 11-11 05:00 cefepime per protocol IV
ORD-000045 11-09 10:54 blood_culture: blood cultures x2

Notes

History and physical · DOC-000189 · Dr. Greta Kowalczyk (resident) · Mon Nov 09, 2026 01:24 PM

Cited facts from this note (1)

infection_source: multifocal pneumonia · cited p. 1, line 5 · confidence 0.85

Show source for infection_source

… 6-11-09 10:24 Service: Hospital Medicine Attending: Dr. Wes Merriweather History of present illness: 49-year-old man admitted with sepsis. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started. Past medical history: none significant. Review of systems otherwise negative. Exam: Lungs: scattered crackles at …

Source document DOC-000189: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Elena Okafor   MRN: MRN76087701   Admitted: 2026-11-09 10:24
Service: Hospital Medicine   Attending: Dr. Wes Merriweather

History of present illness: 49-year-old man admitted with sepsis. Chest x-ray shows multifocal pneumonia; blood cultures drawn and ceftriaxone started.
Past medical history: none significant.
Review of systems otherwise negative.
Exam: Lungs: scattered crackles at the bases, no distress.
Assessment and plan:
1. Sepsis: antibiotics, fluids.
2. Community-acquired pneumonia: antibiotics.
3. CKD: renally dose medications.

Nutrition assessment · DOC-000188 · Dario Larkspur, RD (dietitian) · Tue Nov 10, 2026 02:24 PM

Cited facts from this note (9)

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

Show source for fat_loss

… ontext: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 5.6% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Grip strength: reduced per dynamometry. Recommendations: high-protein oral supplement; calorie counts; weekly …
fluid_accumulation: none · cited p. 1, line 7 · confidence 0.90

Show source for fluid_accumulation

… needs for 10 days. Weight history: 5.6% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Grip strength: reduced per dynamometry. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
grip_strength: reduced · cited p. 1, line 8 · confidence 0.90

Show source for grip_strength

… ght history: 5.6% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Grip strength: reduced per dynamometry. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
intake_days: 10 · cited p. 1, line 5 · confidence 0.95

Show source for intake_days

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Elena Okafor MRN: MRN76087701 Context: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 5.6% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulat …
intake_pct: 40 · cited p. 1, line 5 · confidence 0.95

Show source for intake_pct

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Elena Okafor MRN: MRN76087701 Context: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 5.6% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulat …
muscle_loss: moderate · cited p. 1, line 7 · confidence 0.90

Show source for muscle_loss

… ated energy intake 40% of needs for 10 days. Weight history: 5.6% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Grip strength: reduced per dynamometry. Recommendations: high-protein oral supplement; calorie counts; weekly weights.
nutrition_context: acute · cited p. 1, line 4 · confidence 0.95

Show source for nutrition_context

NUTRITION ASSESSMENT (Registered Dietitian) Patient: Elena Okafor MRN: MRN76087701 Context: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 5.6% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subc …
weight_loss_days: 30 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_days

… egistered Dietitian) Patient: Elena Okafor MRN: MRN76087701 Context: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 5.6% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Grip strength: reduced per dynamometry. Re …
weight_loss_pct: 5.6 · cited p. 1, line 6 · confidence 0.95

Show source for weight_loss_pct

… egistered Dietitian) Patient: Elena Okafor MRN: MRN76087701 Context: acute illness Intake: estimated energy intake 40% of needs for 10 days. Weight history: 5.6% weight loss over 30 days. Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation. Grip strength: reduced per dynamometry. Re …

Source document DOC-000188: Nutrition assessment (synthetic)

NUTRITION ASSESSMENT (Registered Dietitian)
Patient: Elena Okafor   MRN: MRN76087701

Context: acute illness
Intake: estimated energy intake 40% of needs for 10 days.
Weight history: 5.6% weight loss over 30 days.
Nutrition-focused physical exam: moderate loss of subcutaneous fat; moderate muscle wasting; no fluid accumulation.
Grip strength: reduced per dynamometry.
Recommendations: high-protein oral supplement; calorie counts; weekly weights.

Progress note · DOC-000190 · Dr. Greta Kowalczyk (resident) · Fri Nov 13, 2026 02:55 PM · awaiting cosign

Source document DOC-000190: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Elena Okafor   MRN: MRN76087701   Hospital day 5

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Sepsis: continue current management.
2. Malnourished: dietitian following.

Resident: Dr. Greta Kowalczyk   Attending cosign: pending